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Longitudinally extensive transverse myelitis with pulmonary tuberculosis: Two case reports.
Medicine (Baltimore). 2018 Jan; 97(3):e9676.M

Abstract

RATIONALE

Longitudinally extensive transverse myelitis (LETM) is characterized by contiguous inflammatory lesions of spinal cord extending to ≥3 vertebral segments. The etiology of LETM is complicated, including various infection, autoimmune disease, and so on. Neuromyelitis optic spectrum disorder (NMOSD) is the most common cause of LETM. Several case reports have suggested the associations between NMOSD and pulmonary tuberculosis (PTB).

PATIENT CONCERNS

Patient 1, a 20-year-old woman who had a past history of PTB, presented with weakness, numbness, and pain in the limbs. The serum anti-aquaporin-4 antibody (AQP4-Ab) was strongly positive, and the magnetic resonance imaging (MRI) scan of cervical and thoracic spinal cord after admission to the hospital revealed hyperintensity lesions extending from C3 to T8 on T2-weighted (T2W) image, T1-weighted (T1W) image, and fluid-attenuated inversion recovery (FLAIR) image. Patient 2, a 21-year-old woman who had a past medical history of PTB without receiving any treatment, presented for numbness in bilateral lower limbs and in the chest. The anti-AQP4-Ab was negative both in the serum and in the cerebral spinal fluid (CSF) of the patient. The MRI scan during hospitalization of cervical and thoracic spinal cord revealed diffuse hyperintense signal extending C3 to T11 on T2W and FLAIR images and hypointense signal on T1W image.

DIAGNOSIS

The first patient was diagnosed with anti-AQP4-Ab positive NMOSD, while the second case was an anti-AQP4-Ab negative LETM patient.

INTERVENTIONS

Both of the patients received a combination of corticosteroid and anti-tuberculosis (isonicotinyl hydrazide 0.3 g/d, rifampin 0.45 g/d, pyrazinamide 1 g/d, and ethambutol 1 g/d) treatment.

OUTCOMES

The patients were followed up for up to 1 year. The Expanded Disability Status Scale (EDSS) of both patients were decreased and the lesion size in the spinal cord was significantly reduced at the time point of the follow-up.

LESSONS

Combination of anti-tuberculosis and corticosteroid treatment may have better prognosis for patient of LETM with PTB.

Authors+Show Affiliations

Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29505015

Citation

Zhang, Yu, et al. "Longitudinally Extensive Transverse Myelitis With Pulmonary Tuberculosis: Two Case Reports." Medicine, vol. 97, no. 3, 2018, pp. e9676.
Zhang Y, Zhu M, Wang L, et al. Longitudinally extensive transverse myelitis with pulmonary tuberculosis: Two case reports. Medicine (Baltimore). 2018;97(3):e9676.
Zhang, Y., Zhu, M., Wang, L., Shi, M., & Deng, H. (2018). Longitudinally extensive transverse myelitis with pulmonary tuberculosis: Two case reports. Medicine, 97(3), e9676. https://doi.org/10.1097/MD.0000000000009676
Zhang Y, et al. Longitudinally Extensive Transverse Myelitis With Pulmonary Tuberculosis: Two Case Reports. Medicine (Baltimore). 2018;97(3):e9676. PubMed PMID: 29505015.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Longitudinally extensive transverse myelitis with pulmonary tuberculosis: Two case reports. AU - Zhang,Yu, AU - Zhu,Mingqin, AU - Wang,Lifang, AU - Shi,Miao, AU - Deng,Hui, PY - 2018/3/6/entrez PY - 2018/3/6/pubmed PY - 2018/3/16/medline SP - e9676 EP - e9676 JF - Medicine JO - Medicine (Baltimore) VL - 97 IS - 3 N2 - RATIONALE: Longitudinally extensive transverse myelitis (LETM) is characterized by contiguous inflammatory lesions of spinal cord extending to ≥3 vertebral segments. The etiology of LETM is complicated, including various infection, autoimmune disease, and so on. Neuromyelitis optic spectrum disorder (NMOSD) is the most common cause of LETM. Several case reports have suggested the associations between NMOSD and pulmonary tuberculosis (PTB). PATIENT CONCERNS: Patient 1, a 20-year-old woman who had a past history of PTB, presented with weakness, numbness, and pain in the limbs. The serum anti-aquaporin-4 antibody (AQP4-Ab) was strongly positive, and the magnetic resonance imaging (MRI) scan of cervical and thoracic spinal cord after admission to the hospital revealed hyperintensity lesions extending from C3 to T8 on T2-weighted (T2W) image, T1-weighted (T1W) image, and fluid-attenuated inversion recovery (FLAIR) image. Patient 2, a 21-year-old woman who had a past medical history of PTB without receiving any treatment, presented for numbness in bilateral lower limbs and in the chest. The anti-AQP4-Ab was negative both in the serum and in the cerebral spinal fluid (CSF) of the patient. The MRI scan during hospitalization of cervical and thoracic spinal cord revealed diffuse hyperintense signal extending C3 to T11 on T2W and FLAIR images and hypointense signal on T1W image. DIAGNOSIS: The first patient was diagnosed with anti-AQP4-Ab positive NMOSD, while the second case was an anti-AQP4-Ab negative LETM patient. INTERVENTIONS: Both of the patients received a combination of corticosteroid and anti-tuberculosis (isonicotinyl hydrazide 0.3 g/d, rifampin 0.45 g/d, pyrazinamide 1 g/d, and ethambutol 1 g/d) treatment. OUTCOMES: The patients were followed up for up to 1 year. The Expanded Disability Status Scale (EDSS) of both patients were decreased and the lesion size in the spinal cord was significantly reduced at the time point of the follow-up. LESSONS: Combination of anti-tuberculosis and corticosteroid treatment may have better prognosis for patient of LETM with PTB. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/29505015/Longitudinally_extensive_transverse_myelitis_with_pulmonary_tuberculosis:_Two_case_reports_ L2 - http://dx.doi.org/10.1097/MD.0000000000009676 DB - PRIME DP - Unbound Medicine ER -