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We report a 19-year-old male presenting with acute, painless flaccid paraplegia and urinary retention following brief flu-like symptoms. The Rapid onset in hours and preserved joint position sense initially suggested spinal cord infarction. However, MRI revealed a longitudinally extensive hyperintense signal from T5 to the conus medullaris, involving the grey matter—an atypical finding that supported an infectious aetiology.Cerebrospinal fluid analysis showed lymphocytic pleocytosis, and Epstein-Barr virus was confirmed via monospot testing and CSF PCR.Treatment included a course of intravenous methylprednisolone, five sessions of plasma exchange, and a 2-week regimen of intravenous acyclovir.On discharge, the patient had improved lower limb strength (MRC grade 4/5 in hip flexion, 5/5 distally) but remained spastic with gait disturbance and required intermittent self-catheterization. He was transferred for spinal rehabilitation.This case highlights the importance of recognising grey matter-predominant MRI findings in distinguishing EBV-associated longitudinally extensive transverse myelitis from spinal cord infarction in acute myelopathy.drtrq@outlook.com