Tuberculous Transverse Myelitis

In Brief Acute transverse myelitis is an inflammatory disorder of the spinal cord, characterized by acute or subacute onset of paraparesis, bilateral sensory deficit, and impaired sphincter function. Also characteristic are a spinal segmental sensory level and the lack of clinical or laboratory evidence of spinal cord compression. Mycobacterium tuberculosis is a very rare cause of transverse myelitis. An abnormal activation of the immune system against the spinal cord is thought to be the main etiologic mechanism. Other suspected mechanisms are the direct invasion by the bacillus and the toxic effect of antituberculous drugs. Diagnosis is achieved through the patient's medical history and the analysis of cerebrospinal fluid, magnetic resonance imaging of the spinal cord, and bacteriological confirmation of tuberculous infection. We present a patient with acute transverse myelitis secondary to miliary tuberculosis who had marked clinical improvement and neurologic recovery after treatment of tuberculosis and intravenous steroid pulses. Acute transverse myelitis is a neurologic syndrome caused by inflammation of the spinal cord. Several viral and bacterial infections may be associated with myelitis, including tuberculosis. This article presents a case with miliary tuberculosis and transverse myelitis and reviews the etiology, pathophysiological mechanisms, and treatment of this condition.