| Popis: |
A previously healthy 45-year-old man had development of neck pain and swelling, followed 1 week later by fevers, chills, and night sweats. Cervical computed tomography showed a left-sided cervical soft-tissue abscess. The patient was treated with oral cephalexin for 10 days, without benefit. Fine-needle aspiration biopsy of the mass showed granulomatous inflammation and a heterogeneous lymphocyte population without evidence of malignancy. Meropenem and gentamicin were started. Ten days later, he had development of acute urinary retention, numbness and weakness in the lower extremities, and numbness in the upper extremities. At symptom nadir 2 days later, he required the aid of a walker to ambulate. Lhermitte sign and erectile dysfunction were also present. The patient was admitted to the hospital. Spinal cord magnetic resonance imaging showed a longitudinally extensive, nonenhancing, T2-hyperintense lesion predominantly affecting the ventral and lateral parenchyma of the cervical and thoracic spinal cord. Cerebrospinal fluid examination showed a white blood cell count of 581 cells/µL with 42% neutrophils, 35% lymphocytes, and 22% monocytes, increased protein concentration (109 mg/dL), and normal glucose concentration. A diagnosis of postinfectious idiopathic transverse myelitis was made. The patient was treated with intravenous immunoglobulin, intravenous methylprednisolone, and broad-spectrum antibiotics, with improvement of both the abscess and his neurologic symptoms. After discharge, he was able to walk unassisted. At follow-up evaluation 6 months after the initial evaluation, neurologic examination showed only mild weakness of the left iliopsoas muscle and brisk reflexes in the lower extremities. Acute transverse myelopathies are a heterogeneous group of spinal cord disorders characterized by acute or subacute signs and symptoms of spinal cord dysfunction, typically a combination of sensory, motor, and autonomic manifestations. Underlying causes include vascular, infectious, neoplastic, postirradiation, traumatic, and inherited/metabolic, and inflammatory processes. |
