Central spinal cord syndrome secondary to infectious myelitis caused by MycobacteriumTuberculosis

Abstract

Background: Tuberculosis is a global public health problem that affects the population. Caused by Mycobacterium tuberculosis, it is transmitted through air droplets and extrapulmonary presentation affects 5–45% of the infected population. Spinal tuberculosis is a chronic and progressive disease, secondary to the spread of a primary focus, which can go unnoticed. Case description: Male patient with fever of 4 days of evolution, nocturnal, with diaphoresis, weakness of strength of bilateral upper and lower limbs; lower limbs with (0) strength and upper limbs (1), absence of deep tendon reflexes in both pairs of limbs, C4 sensory level, with absence of sphincter control. The diagnosis was established by diagnostic thoracentesis, performing GeneXpert and pleural fluid culture, positive for tuberculosis and negative for resistant mycobacteria; MRI with gadolinium identifies hyperintense cervical spinal cord area from C2 to C4, producing an increase in the diameter of the spinal cord. Tetraconjugate treatment was started: isoniazid, rifampicin, pyrazinamide and ethambutol. Four weeks after the beginning of treatment, the patient presents (2) strength in the lower limbs and (3) in the upper limbs, continuing with physical therapy. Conclusion: tuberculosis presents in very diverse ways and should be kept in mind in young patients without a personal pathological history who present symptoms of fever as one of the first symptoms. Serological diagnostic tests, GeneXpert and imaging such as magnetic resonance imaging help in establishing a diagnosis. Tuberculosis should always be considered an infectious process whose etiology is unknown.