Association between neuromyelitis optica and tuberculosis in a Chinese population

Abstract

BackgroundA number of reports have described the presence of tuberculosis (TB) in neuromyelitis optica (NMO) patients. However, a definite association between the two conditions has not been conclusively demonstrated.MethodsTo investigate the association between NMO and TB in a Chinese population, we performed a retrospective review of hospital records of NMO patients, control patients and tuberculosis meningitis (TBM) patients from January 1, 1995 to December 31, 2011.ResultsThe frequency of preceding/simultaneous active pulmonary TB (PTB) was not significantly different between NMO patients (1.1%) and control groups (2.3% in myasthenia gravis, 1.1% in polymyositis or dermatomyositis, zero in idiopathic facial palsy and viral meningitis/meningoencephalitis). NMO cases differed from TBM cases in terms of demographics, course (recurrent or monophasic), cerebrospinal fluid analysis and magnetic resonance images. Two TBM patients shared partial clinical features with NMO (one of the TBM patients had a longitudinal extensive spinal cord lesion involving the holocord, and the other had optic neuritis before anti-tuberculosis treatment). NMO antibodies were only detected in NMO patients and not in TBM patients with myelitis or optic neuritis.ConclusionsWe could not confirm previous suggestions of the association between PTB and NMO. Direct infection of the central nervous system by TB may mimic NMO in some respects, but whether NMO-like symptoms that develop during the course of TB should be considered and diagnosed as NMO is open to discussion.

Occult disseminated tuberculosis with holocord longitudinally extensive transverse myelitis: A rare phenomenon in a child

“…LETM are seen rarely in childhood MTB, and holocord LETM has been reported in only one patient. [ 3 ] To the best of our knowledge, our patient is the second case. In Sahu's study, four MTB adult patients have been reported with LETM without holocord.…”

“…The appearance through magnetic resonance imaging (MRI) of spinal cord lesions and serum NMO-IgG positivity plays a central role in NMO diagnose. [ 1 2 3 ] Different studies in children with NMO have reported a wide range of AQP4-IgG seropositivity (7%–80%). Nevertheless, 10%–40% of patients diagnosed with NMO remain seronegative for AQP4 antibodies.…”

Neuromyelitis optica spectrum disorder and active tuberculosis

“…At present the association between NMOSD and TB remains unconfirmed, with the literature largely reporting individual cases and small case series from localised regions, with or without identified control groups. Furthermore, Li et al reported the largest case series to date (88 patients) and did not demonstrate a significant increased incidence of TB in their Chinese population 18. Finally, a small prospective controlled trial of antituberculous treatment for managing steroid refractory NMO suggested these drugs could improve outcome in NMO, an intriguing suggestion which requires further research 19…”

“…An association between NMOSD and TB has been reported over the past 50 years 6 14–22. Silber et al 15 described eight patients with pulmonary TB and myelitis or optic neuropathy without evidence of central nervous system TB: six developed NMOSD, one an acute necrotising myelopathy and one an optic neuropathy.…”

Distal cord-predominant longitudinally extensive myelitis with diffuse spinal meningitis and dural abscesses due to occult tuberculosis: A rare occurrence

“…Although previous reports mention a correlation between TB and NMO, a recent report failed to find a significant correlation. [ 8 9 ]…”