Tuberc Respir Dis.  2006 Mar;60(3):353-356.

A case of Transverse Myelitis due to Multidrug-Resistant Tuberculosis

• Lee KH
• Ra SW
• Park IN
• Choi HS
• Jung H
• Chon GR
• Shim TS

Abstract

Acute transverse myelitis (TM) is a neurological syndrome caused by inflammation of the spinal cord. TM is rare but is frequently caused by viral or bacterial infections. TM caused by tuberculosis (TB) is extremely rare and there are no reports of TM caused by multidrug-resistant TB (MDR-TB). We report a case of acute TM due to MDR-TB in a 40-year-old man. The patient had been diagnosed with pulmonary TB and was started on the first-line anti-TB treatment. However, the chest radiographic findings were aggravated and neurological symptoms such as weakness in both lower extremities, sensory changes, and voiding difficulty were newly developed. The T2-weighted magnetic resonance image of the spine showed diffusely increased signal intensity in the spinal cord, particularly at the lower cervical and upper thoracic levels, without any definite evidence of myeloradicular compression, which is consistent with a diagnosis of TM. A drug susceptibility test revealed MDR and second-line anti-TB drugs were prescribed. The chest radiographic findings showed improvement after treatment, the mycobacterial culture converted to negative, the MRI findings improved, and there was partial improvement in the low extremity weakness. The patient has been prescribing second-line anti-TB medications for 14 months.

Keyword

Transverse myelitis; Tuberculosis; Multidrug resistance; Mycobacterium tuberculosis

MeSH Terms

Adult
Bacterial Infections
Diagnosis
Drug Resistance, Multiple
Extremities
Humans
Inflammation
Lower Extremity
Magnetic Resonance Imaging
Mycobacterium tuberculosis
Myelitis, Transverse*
Radiography, Thoracic
Spinal Cord
Spine
Tuberculosis
Tuberculosis, Multidrug-Resistant*

Figure

• 

  Figure 1 Serial chest X-ray findings. A. Chest X-ray finding upon admission. B. Improveding chest radiographic findings, 14 months after second-line anti-TB medications.

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  Figure 2 Serial spinal MRI findings. A. Sagittal T2-weighted image of the spine shows diffusely increased signal intensity in the spinal cord (arrow), especially at the lower cervical and upper thoracic levels. B. Sagittal T2-weighted image of the spine shows decreased signal intensity (arrow), 2 months after being administered the second-line anti-TB medications.

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