A case report of long-segment tuberculous myelitis with concomitant tuberculous meningitis.

BACKGROUND: Tuberculous myelitis is a form of central nervous system tuberculosis (TB) that can be associated with intracranial involvement but rarely presents with extensive longitudinal involvement of more than one segment. We are reporting a case with tuberculous meningitis and long-segment myelitis in a previously undiagnosed patient with TB.

CASE DESCRIPTION: A 53-year-old hypertensive male, presented with subacute lower limbs weakness, sensory level below his nipples, and urine retention. Erythrocyte sedimentation rate (ESR) was above 112 mm/hour. Magnetic resonance imaging (MRI) spine showed a long segment of hyperintense signal seen on the T2-weighted image (T2WI) images in the spinal cord extending from C6 to D3 vertebral segments, with heterogeneous post-contrast enhancement. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis with high protein and low glucose, and polymerase chain reaction (PCR) for(MBTB) was positive. The patient received intravenous methylprednisolone daily for 5 days and standard anti-TB medications [rifampicin, isoniazid (INH), pyrazinamide, and ethambutol] for 12 months. However, repeated CSF analysis 3 months after starting anti-TB medications showed a negative PCR for MBTB, normal cell count, and glucose with slightly elevated protein. Still, the patient did not show any clinical improvement.

CONCLUSIONS: Long-segment tuberculous myelitis (LSTM) is a rare form of central nervous system TB that can be accompanied by tuberculous meningitis. It must be considered a differential diagnosis of neuromyelitis optica spectrum disorder (NMOSD), especially in endemic areas of TB, as the management approach is completely different.