1224 - Cocaine and Marijuana Use as a Novel Etiology for Acute Transverse Myelitis

A 48-year-old male with a history of recent marijuana and cocaine use, hypertension, and transient ischemic attack presented to the emergency department with severe right upper extremity pain that migrated down to the ipsilateral forearm and spread to the remaining limbs. The patient’s pain was accompanied by acute onset tetraparesis. Transverse myelitis (TM) was suspected, and his symptoms improved with IV methylprednisolone administration. Upon discharge, the patient was nearly back to his prior level of function, which at baseline was independent with ADLs and ambulation. He did not require assistive devices.

Discussions:

Transverse myelitis is commonly caused by infections or autoimmune conditions, but it can also be secondary to other pathologies or idiopathic conditions. To date, only a handful of reports have linked cocaine use to ischemic myelopathy, but none to myelitis. This patient denied recent illness or the presence of any known autoimmune conditions or blood disorders. Therefore, it is likely that recent marijuana and cocaine use contributed to his acute presentation, as drugs are known to promote inflammatory processes. Prior to treatment, the patient experienced debilitating weakness to all four extremities, becoming unable to perform any task independently. Fortunately, his symptoms significantly improved with steroids, which helped to confirm a diagnosis of TM. 

Conclusions:

While rare, TM has several known etiologies. In this case, we demonstrate a novel relationship between drug use and acute TM. Investigations into the relationship between cocaine, marijuana or other drug use and TM should be further explored to better diagnose and treat patients with this pathology.