A case of Transverse Myelitis due to Multidrug-Resistant Tuberculosis.

Lee, Kwang Ha; Ra, Seung Won; Park, I Nae; Choi, Hye Sook; Jung, Hoon; Chon, Gyu Rak; Shim, Tae Sun

doi:2006.60.3.353

Tuberc Respir Dis > Volume 60(3); 2006 > Article

Case Report

Tuberculosis and Respiratory Diseases 2006;60(3):353-356.
DOI: https://doi.org/10.4046/trd.2006.60.3.353 Published online March 1, 2006.

A case of Transverse Myelitis due to Multidrug-Resistant Tuberculosis.

Kwang Ha Lee, Seung Won Ra, I Nae Park, Hye Sook Choi, Hoon Jung, Gyu Rak Chon, Tae Sun Shim

Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. shimts@amc.seoul.kr

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.

Key Words: Transverse myelitis, Tuberculosis, Multidrug resistance, Mycobacterium tuberculosis