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Alayafi HA, Alruwaili M, Aljumah TK, Alshehri A, Alrasheed D, Alanazi MF, AlRuwaili R, Ali NH, Albarrak AM, AlRashdi BM, Taha AE. Mycoplasma pneumoniae and Schistosoma mansoni co-infection in a young patient with extensive longitudinal acute transverse myelitis. J Infect Dev Ctries 2022; 16:1933-1938. [PMID: 36753653 DOI: 10.3855/jidc.17023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/02/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Acute transverse myelitis is an uncommon inflammatory, intramedullary, disorder of the spinal cord. Spastic paraplegia, impaired sphincter functions, and sensory loss, with sensory level, are the clinical manifestations of this devastating disorder. The utilization of magnetic resonant imaging (MRI) contributes to the surge in the diagnosis of more ATM cases. Although the causes of ATM are numerous, both Mycoplasma pneumoniae and Schistosoma mansoni are uncommon causes and their co-existence in the same patient has not been reported before in Saudi Arabia. CASE We report a 25-year-old ATM male patient presented with a history of sudden onset severe low back pain. Within four hours from the onset of the back pain, he became completely paraplegic with impaired functions of the bowel and urinary bladder sphincter. Furthermore, he lost all modalities of sensory functions in the lower limbs. His examination revealed spastic complete paraplegia with sensory level at T6. Clinical neurological examination revealed normal upper limbs and brain functions. The MRI of the cervico-dorsal spine showed extensive longitudinal hyperintense lesion extending from the upper cervical segments to the lower dorsal segments (extensive longitudinal transverse myelitis). A post-infectious immune-mediated predisposition was highly suspected due to the very high titers of anti-Mycoplasma pneumoniae IgM and IgG that were detected. The immunosuppressant therapy did not improve his paraplegia. A spinal cord biopsy revealed the presence of several Schistosoma mansoni ova surrounded by chronic inflammatory reactions and reactive gliosis. CONCLUSIONS Both Mycoplasma pneumoniae and Schistosoma mansoni should be investigated in cases with extensive longitudinal ATM.
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Affiliation(s)
- Hassan Ali Alayafi
- King Saud bin Abdulaziz University for health sciences, Riyadh, Saudi Arabia
| | - Mubarak Alruwaili
- Department of Internal Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | | | - Ali Alshehri
- King Faisal Specialist Hospital and Research Centre, Neuroscience Center, Riyadh, Saudi Arabia
| | - Deema Alrasheed
- Stroke and Neurology Consultant, Head of the Neurology Unit, Sulaiman Al Habib Medical Group, Arrayan Hospital, Riyadh, Saudi Arabia
| | - Muhannad Faleh Alanazi
- Department of Internal Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Raed AlRuwaili
- Department of Internal Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Naif H Ali
- Internal Medicine Department, Medical College, Najran University, Najran, Saudi Arabia
| | - Anas Mohammad Albarrak
- Internal Medicine Department, Medical College, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Barakat M AlRashdi
- Department of Biology, College of Science, Jouf University, Sakaka, Saudi Arabia
| | - Ahmed E Taha
- Medical Microbiology and Immunology Unit, Department of Pathology, College of Medicine, Jouf University, Sakaka, Saudi Arabia
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Abbas SA, El Helou J, Chalah MA, Hilal H, Saliba G, Abboud H, Ayache SS. Longitudinal Extensive Transverse Myelitis in an Immunocompetent Older Individual-A Rare Complication of Varicella-Zoster Virus Reactivation. ACTA ACUST UNITED AC 2019; 55:medicina55050201. [PMID: 31126152 PMCID: PMC6572170 DOI: 10.3390/medicina55050201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/24/2019] [Accepted: 05/21/2019] [Indexed: 12/29/2022]
Abstract
Varicella-zoster virus (VZV) is a human neurotropic herpes virus that causes chickenpox in children. After becoming latent in dorsal root ganglia, it can reactivate to cause dermatological manifestations, the most common one being shingles or herpes zoster. Severe neurologic dysfunctions can occur in immunocompromised patients such as encephalitis, meningitis, myelitis and neuropathy. Longitudinal extensive transverse myelitis (LETM) is an unusual neurological complication mainly described in immunocompromised patients, with very few cases described in immunocompetent ones. We hereby report a case of VZV-induced LETM in an immunocompetent older adult—a situation rarely described in the literature. LETM is a rare complication of VZV and its pathogenesis; therapeutic interventions and prognosis are far from being fully clarified. However, a prompt diagnosis is needed to allow a rapid initialization of treatment and ensure a better outcome. Although the therapeutic lines are not clear, immunosuppressive agents may have their place in cases of unsuccessful results and/or relapses following acyclovir coupled with a well conducted methylprednisolone therapy. Further studies are highly needed to improve the current understanding of the disease course and mechanisms, and to optimize therapeutic strategies.
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Affiliation(s)
- Samar A Abbas
- Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Jeanine El Helou
- Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France.
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94010 Créteil, France.
| | - Hanine Hilal
- Department of Neurology, Bellevue Medical Center University Hospital, Beirut 1104-2020, Lebanon.
| | - Gaby Saliba
- Department of Infectious diseases, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Halim Abboud
- Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France.
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94010 Créteil, France.
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Abstract
Behçet's disease is a chronic, relapsing inflammatory disorder of unknown etiology. Neuro-Behçet's disease (NBD) occurs in approximately 5 to 49% of patients with Behçet's disease. Spinal cord involvement is very rare in NBD. In this article, we report a 22-year-old male patient of NBD with longitudinal myelitis involving the entire spinal cord. Patient was admitted with one-week of headache, vomiting, and urinary incontinence. Before admission, he felt motor weakness for two years and had noticed recurrent genital and oral ulcers with a frequency of more than three episodes per year for five years. T2-weighted spinal magnetic resonance images showed hyperintensities within the entire spinal cord. He was diagnosed as NBD with longitudinal myelitis. Intravenous methylprednisolone (120 mg/day) was administered for three days, followed by an oral administration of prednisolone (45 mg/day). In conjunction with the steroid therapy, intravenous cyclophosphamide (0.4 g/week) was administered twice. Rapid improvements were detected after receiving treatments for half a month. NBD associated longitudinal myelitis is really rare. This case provided important implications for the diagnosis and treatment of longitudinal myelitis in NBD patients.
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Affiliation(s)
- T Yamamoto
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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