Fig. 1.
Clinical course and MRI findings of our patient. (A) An 85-year-old man presented with vertigo and vomiting one day after receiving the second dose of the Pfizer-BioNTech coronavirus disease 2019 vaccine (BNT162b2). On the 3rd day after vaccination, the patient's symptoms improved. However, he presented with progressive paraplegia, hypoesthesia in the lower limbs bilaterally, and urinary retention, which prompted referral to our hospital. He was diagnosed with acute transverse myelitis. A three-day course of intravenous methylprednisolone (0.5 g) was initiated. However, the patient's neurological symptoms did not improve. Subsequently, he developed bilateral pneumonia. Treatment with sulbactam/ampicillin (6 g/day) did not resolve his condition. On the 58th day after vaccination, he died. (B, C) Thoracic MRI demonstrates a longitudinal hyperintense lesion at the Th3–5 vertebral levels (red arrow) (B: sagittal image, C: axial image at the Th4 vertebral level).