Acute Transverse Myelitis at the Conus Medullaris Level After Rabies Vaccination in a Patient With Behcet's Disease

Abstract

Case report: A 25-year-old man with Behçet's disease was admitted because of weakness of the lower limbs and difficulty in urination. He had received a rabies vaccination 2 months previous because he had been bitten by a dog. Findings: Clinical and laboratory findings supported acute transverse myelitis. A hyperintense lesion and expansion at the level of conus medullaris was detected on spinal magnetic resonance imaging. Conclusion: Although neurologic involvement is one of the main causes of mortality and morbidity in Behçet's disease, the factors that aggravate the involvement of the nervous system are still unclear. Vaccination may have been the factor that had activated autoimmune mechanisms in this case. To our knowledge, involvement of the conus medullaris in Behçet's disease after rabies vaccination has not been reported.

Identifying Transverse Myelitis in the Emergency Care Arena

“…The patient was sent to physiotherapy and required intermittent bladder catheterization. A year later, all of the neuropathological symptoms were alleviated, and the MRI was normal (Bir et al, 2007). More importantly, after a year, the patient was symptom-free and had a normal MRI, supporting the importance of rapid diagnosis and treatment of TM.…”

“…Case study #2 (Bir, Esmeli, Cenikli, Cagdas, & Degirmenci, 2007): Two months after receiving rabies vaccinations for a dog bite, a 25-year-old man presented with the chief complaint of weakness in his lower limbs and urinary retention. On physical examination, his muscle strength was decreased in lower limbs, and he had decreased sensation below L-1.…”

Self‐inflicted oral injury in an infant with transverse myelitis

“…According to Vergara et al, 2 ATM can be caused by vascular lesions, acute inflammation, neoplasias, paraneoplasias, collagen vascular diseases, and iatrogenic causes. The disorders are present in approximately 30% to 40% of individuals with a minor viral illness 1,2,4–6 . ATM is a rare disease, having an incidence of one to four cases per million, and can affect individuals of all ages 2,3,7 .…”

“…Infectious agents, such as Epstein‐Barr, herpes, influenza, rubella, mumps, measles, and zoster viruses may be involved in this condition 2,6 . Pidcock et al 7 studied 47 cases of ATM in children and found that 47% occurred following a high fever and 28% occurred after vaccination 1,5 . The implicated vaccines were polio, trivalent, hepatitis B, trivalent bacterial, influenza, varicella, smallpox, Japanese B encephalitis, and Haemophilus influenzae.…”

“…2,6 Pidcock et al 7 studied 47 cases of ATM in children and found that 47% occurred following a high fever and 28% occurred after vaccination. 1,5 The implicated vaccines were polio, trivalent, hepatitis B, trivalent bacterial, influenza, varicella, smallpox, Japanese B encephalitis, and Haemophilus influenzae. It is important to note that the location of the blockage along the spinal column determines the severity of the symptoms.…”