Para infectious myelitis with Conus medullaris immunotropism in the immune phase of leptospirosis infection: Clinical pattern and in silico molecular mimicry analysis based biological plausibility.
Nelabhotla Sai Satya Saranya, Rithvik Ramesh, Vengadakrishnan Krishnamoorthy et al.
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Case in brief
Three patients with serologically confirmed leptospirosis developed acute myelitis during the immune phase, presenting with bladder dysfunction and lower limb weakness after a febrile illness. MRI revealed conus medullaris involvement, and cerebrospinal fluid analysis showed inflammatory changes. Treatment with steroids and immunotherapy led to clinical improvement, suggesting a para-infectious myelitis pattern associated with leptospirosis.
What made this case unusual
The conus medullaris involvement in myelitis following leptospirosis is not systematically described, highlighting a potential region-specific vulnerability to immune-mediated injury.
Diagnostic / clinical pearl
Clinicians should consider leptospirosis as a potential cause of acute myelitis, particularly in endemic areas, and recognize the conus medullaris as a site of involvement.
Why it matters
Understanding the immune-mediated mechanisms and patterns of neurological involvement in leptospirosis can enhance early diagnosis and treatment strategies in affected patients.