Acute Transverse Myelitis Complicating the Third Trimester of Pregnancy: A Rare Case of Progressive Neurological Recovery and Favorable Obstetric Outcome

Transverse myelitis (TM) is a rare immune-mediated inflammatory disorder of the spinal cord.It can result in sensory, motor, and autonomic deficits of varying severity.Its occurrence during pregnancy is uncommon and presents specific diagnostic, therapeutic, obstetric, and anesthetic challenges.We report the case of a 24-year-old para 2 woman who developed an acute febrile spinal cord syndrome at 30 weeks of gestation, characterized by rapidly progressive tetraparesis, sensory impairment, and sphincter dysfunction.Neurological deficits progressed to a nadir within the first 24 hours.Spinal magnetic resonance imaging performed on the first day demonstrated an extensive T2-hyperintense lesion extending from C5 to T1, consistent with acute TM, with no evidence of spinal cord compression.Cerebrospinal fluid analysis showed lymphocytic pleocytosis.Brain MRI was normal, anti-AQP4 and anti-MOG antibodies were negative, and no specific infectious agent was identified.A parainfectious etiology was suspected but could not be definitively established.The patient received high-dose intravenous methylprednisolone, initially combined with empirical anti-infective therapy.Her neurological status progressively improved, and the pregnancy was continued under maternal and fetal surveillance to 37 weeks of gestation.Because of residual motor impairment, reduced mobility, persistent sphincter dysfunction, and concern regarding effective expulsive efforts, cesarean delivery was selected.General anesthesia was chosen following multidisciplinary discussion.A healthy male infant weighing 3100 g was delivered, with Apgar scores of 10/10.At six weeks postpartum, the patient had achieved near-complete motor recovery, with autonomous walking, marked improvement in motor and sensory function, and almost complete resolution of sphincter dysfunction.This case illustrates the importance of early diagnosis, multidisciplinary coordination, and appropriate neurological and obstetric management.Favorable maternal and neonatal outcomes may be achieved despite severe neurological impairment at presentation.