Longitudinally extensive transverse myelitis with mycobacterium tuberculosis infection

Abstract

Longitudinal extensive transverse myelitis (LETM) is defined as a spinal cord lesion that extends over three or more vertebrae, as seen on MRI of the spine [1]. LETM is a common characteristic feature of neuromyelitis optica spectrum disease (NMOSD) or various autoimmune diseases [2]. While in some cases, the common antibodies are negative and related to some hidden and unknown causes. We report a vegetarian woman presented sudden onset of quadriplegia with LETM in cervical and thoracic spinal cord which was confirmed with neuroimaging. On MRI, the patient was found exhibit atypical longitudinal extensive transverse abnormal signals that mimicked NMOSD. We tracked for possible reasons that may be related to LETM and found encranial and pulmonary Mycobacterium tuberculosis (MTB) infection. Systemic screening indicated there was no evidence supporting autoimmune diseases such as NMOSD or paraneoplastic neurological syndrome (PNS). The patient showed good clinical response to anti-tuberculosis therapy, corticosteroids and immunoglobin. Usually diagnosis of LETM from NMOSD or tracking for autoimmune reasons of LETM is difficult. Our case highlights that MTB infection might be an important but overlooked cause of LETM. Symptoms of MTB are usually nonspecific, as seen in the current case, and the duration of symptoms before diagnosis can vary [3]. Case report