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A rare association of tuberculous longitudinally extensive transverse myelitis (LETM) with brain tuberculoma.
Springerplus. 2015; 4:476.S

Abstract

BACKGROUND

Longitudinally extensive transverse myelitis is characterized by contiguous inflammatory lesion of spinal cord involving three or more spinal segments. It is a well-recognized but rare presentation of Mycobacterium tuberculosis infection.

CASE DESCRIPTION

We report a case of young boy diagnosed with multiple brain tuberculomas. He was on antitubercular drugs therapy for 2 months and became asymptomatic. On 2-month followup visit, the patient complained of acute onset progressive sensorimotor, spastic paraparesis with bladder dysfunction. Magnetic resonance imaging of spine showed longitudinally extensive transverse myelitis extending from thoracic spinal segment T2 to T10 level. He was treated with high dose intravenous methylprednisolone therapy and continued on combination of first line four antitubercular drugs. At 6-month followup, patient was able to walk with support. In our patient, clinical features, previous history of brain tuberculoma and spinal neuroimaging confirmed the diagnosis of tuberculous myelitis. The new onset longitudinally extensive transverse myelitis in our patient was may be related to paradoxical response to antitubercular therapy.

CONCLUSIONS

Our case highlights that tubercular infection might be an important but overlooked cause of longitudinally extensive transverse myelitis. Therefore, clinicians should have a high index of suspicion to diagnose this potentially treatable cause especially in high-risk conditions like tuberculosis endemic areas, associated brain tuberculosis and HIV infection. Our case is unique because of paradoxical presentation of longitudinally extensive transverse myelitis in cranial tuberculomas, already on antitubercular treatment.

Authors+Show Affiliations

Department of Neurology, Sawai Man Singh Medical College, Jaipur, Rajasthan India.Department of Neurology, Sawai Man Singh Medical College, Jaipur, Rajasthan India.Department of Radiology, Sawai Man Singh Medical College, Jaipur, Rajasthan India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26361577

Citation

Jain, Rajendra Singh, et al. "A Rare Association of Tuberculous Longitudinally Extensive Transverse Myelitis (LETM) With Brain Tuberculoma." SpringerPlus, vol. 4, 2015, p. 476.
Jain RS, Kumar S, Tejwani S. A rare association of tuberculous longitudinally extensive transverse myelitis (LETM) with brain tuberculoma. SpringerPlus. 2015;4:476.
Jain, R. S., Kumar, S., & Tejwani, S. (2015). A rare association of tuberculous longitudinally extensive transverse myelitis (LETM) with brain tuberculoma. SpringerPlus, 4, 476. https://doi.org/10.1186/s40064-015-1232-z
Jain RS, Kumar S, Tejwani S. A Rare Association of Tuberculous Longitudinally Extensive Transverse Myelitis (LETM) With Brain Tuberculoma. SpringerPlus. 2015;4:476. PubMed PMID: 26361577.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A rare association of tuberculous longitudinally extensive transverse myelitis (LETM) with brain tuberculoma. AU - Jain,Rajendra Singh, AU - Kumar,Sunil, AU - Tejwani,Shankar, Y1 - 2015/09/04/ PY - 2015/05/01/received PY - 2015/08/10/accepted PY - 2015/9/12/entrez PY - 2015/9/12/pubmed PY - 2015/9/12/medline KW - Brain tuberculoma KW - Longitudinally extensive transverse myelitis (LETM) KW - Tuberculosis KW - Tuberculous myelitis SP - 476 EP - 476 JF - SpringerPlus VL - 4 N2 - BACKGROUND: Longitudinally extensive transverse myelitis is characterized by contiguous inflammatory lesion of spinal cord involving three or more spinal segments. It is a well-recognized but rare presentation of Mycobacterium tuberculosis infection. CASE DESCRIPTION: We report a case of young boy diagnosed with multiple brain tuberculomas. He was on antitubercular drugs therapy for 2 months and became asymptomatic. On 2-month followup visit, the patient complained of acute onset progressive sensorimotor, spastic paraparesis with bladder dysfunction. Magnetic resonance imaging of spine showed longitudinally extensive transverse myelitis extending from thoracic spinal segment T2 to T10 level. He was treated with high dose intravenous methylprednisolone therapy and continued on combination of first line four antitubercular drugs. At 6-month followup, patient was able to walk with support. In our patient, clinical features, previous history of brain tuberculoma and spinal neuroimaging confirmed the diagnosis of tuberculous myelitis. The new onset longitudinally extensive transverse myelitis in our patient was may be related to paradoxical response to antitubercular therapy. CONCLUSIONS: Our case highlights that tubercular infection might be an important but overlooked cause of longitudinally extensive transverse myelitis. Therefore, clinicians should have a high index of suspicion to diagnose this potentially treatable cause especially in high-risk conditions like tuberculosis endemic areas, associated brain tuberculosis and HIV infection. Our case is unique because of paradoxical presentation of longitudinally extensive transverse myelitis in cranial tuberculomas, already on antitubercular treatment. SN - 2193-1801 UR - https://www.unboundmedicine.com/medline/citation/26361577/A_rare_association_of_tuberculous_longitudinally_extensive_transverse_myelitis__LETM__with_brain_tuberculoma_ L2 - https://dx.doi.org/10.1186/s40064-015-1232-z DB - PRIME DP - Unbound Medicine ER -
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