Tubercular longitudinally extensive transverse myelitis (LETM): An enigma for primary care physicians.

Autor: Anand KA; Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India., Bhowmik KK; Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India., Sarkar A; Assistant Professor, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India., Ghosh R; Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India., Mandal A; Associate Professor, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India., Swaika B; Professor and Head of the Department, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India., Ray BK; Professor, Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India.
Jazyk: angličtina
Zdroj: Journal of family medicine and primary care [J Family Med Prim Care] 2021 Feb; Vol. 10 (2), pp. 1057-1060. Date of Electronic Publication: 2021 Feb 27.
DOI: 10.4103/jfmpc.jfmpc_2101_20
Abstrakt: Albeit, all forms of tuberculosis (TB) are endemic in India, spinal intramedullary TB and tubercular longitudinally extensive transverse myelitis (LETM) is deemed extremely rare. With recent advances in the field of neurology, autoimmune astrocytopathy (neuromyelitis optica spectrum disorders, NMOSD), myelin-oligodendrocyte glycoprotein associated encephalomyelitis (MOG-EM), metabolic myelopathy, connective tissue diseases and viral infections have gained considerable focus in the list of differentials of LETM whereas tubercular association is often forgotten. This report presents a rare case of acute transverse myelopathy which unveiled previously undiagnosed pulmonary tuberculosis in an adult rural Indian male. The patient responded well to anti-tubercular therapy and corticosteroids. Exact pathogenesis of LETM in TB remains elusive. Association of TB with MOG-EM has been one of the recent hot-cakes. However, an ill-defined immune-inflammatory response to the infectious agent is the likely cause of tubercular LETM. Hence, the primary care physicians who are the first medical contacts of acute LETM cases and in most cases due to diagnostic dilemma there is an unavoidable delay in accurate diagnosis and initiation of therapy. Primary care doctors should nurture a high index of suspicion to diagnose this potentially lifetime-debilitating yet absolutely treatable clinical condition i.e. tubercular LETM.
Competing Interests: There are no conflicts of interest.
(Copyright: © 2021 Journal of Family Medicine and Primary Care.)
Databáze: MEDLINE
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