Tuberculosis-Associated Longitudinally Extensive Transverse Myelitis.
Habib Behjatnia, Antonio Crespo, Cody Davis et al.
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Case in brief
A 51-year-old man with a year of chronic non-productive cough and about 20 days of fever and headache presented with encephalopathy but no focal neurological deficits. He deteriorated, developing respiratory distress and worsening mental status that required intubation. Bronchoalveolar lavage was positive for Mycobacterium tuberculosis by PCR. Brain and spine MRI showed diffuse leptomeningeal enhancement and extensive inflammatory myelitis, without obstruction; CSF testing was negative for autoimmune or paraneoplastic processes but showed elevated inflammatory markers. He received high-dose glucocorticoids, plasmapheresis, and anti-tuberculosis therapy, with moderate improvement, and was discharged after 2 months.
What made this case unusual
The patient had extensive inflammatory myelitis on MRI despite presenting with encephalopathy and no neurological deficits; the report considered it associated with active pulmonary tuberculosis.
Diagnostic / clinical pearl
In a patient with active pulmonary tuberculosis and neurological deterioration, consider tuberculosis-associated longitudinally extensive transverse myelitis, even when focal neurological deficits are absent.