Isolated Tuberculous Transverse Myelitis Without Meningitis Among Patients With AIDS: A Case Report.

Autor:	Angkanavisan K; Division of Infectious Disease, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, THA., Punpichet M; Department of Radiology, Phramongkutklao Hospital and College of Medicine, Bangkok, THA., Nasomsong W; Division of Infectious Disease, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, THA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2023 Dec 17; Vol. 15 (12), pp. e50650. Date of Electronic Publication: 2023 Dec 17 (Print Publication: 2023).
DOI:	10.7759/cureus.50650
Abstrakt:	Acute transverse myelitis is an inflammatory disorder of the spinal cord, characterized by acute or subacute onset of paraparesis, bilateral sensory deficit, and impaired urinary bladder and sphincter tone function. Mycobacterium tuberculosis , a very rare cause of transverse myelitis, especially tuberculous myelitis without meningitis, is extremely rare. The main etiologic mechanism consists of an abnormal activation of the immune system against the spinal cord as well as the direct invasion by the bacillus. We present a 30-year-old Thai woman with AIDS, presenting with paraplegia for two days. Her MRI of the whole spine showed nodular enhancing intramedullary lesions involving the spinal cord at the T11-T12 level, and intramedullary enhancing lesion along the T12 spinal cord to the conus medullaris. Cerebrospinal fluid (CSF) examination revealed only a few white blood cells without hypoglycorrhachia or elevated CSF protein. CSF polymerase chain reaction (PCR) and culture for M. tuberculosis produced negative results. Other investigations did not demonstrate other organ involvement. Spinal cord biopsy at T12 was performed and exhibited diffuse epithelioid histiocytic proliferation admixed with small lymphocytes and plasma cells with numerous acid-fast bacilli (AFB)-positive bacilli organisms. PCR for M. tuberculosis was also detected in spinal cord tissue. Thus, acute transverse myelitis caused by isolated tuberculous myelitis without meningeal involvement was diagnosed. She had marked clinical improvement and neurologic recovery after treatment with anti-tuberculosis and intravenous steroid pulses. Isolated M. tuberculosis spinal tuberculous myelitis without meningitis is exceptionally uncommon and should be carefully considered, particularly in severely immunocompromised individuals residing in regions with a high tuberculosis burden. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2023, Angkanavisan et al.)
Databáze:	MEDLINE
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