Mycobacteria Infection in Incomplete Transverse Myelitis Is Refractory to Steroids: A Pilot Study

Abstract

Incomplete transverse myelitis (ITM) of unknown origin is associated with high rates of morbidity and mortality. This prospective, open-label study was undertaken to determine whether antituberculous treatment (ATT) might help patients with ITM whose condition continues to deteriorate despite receiving IV methylprednisolone treatment. The study consisted of 67 patients with steroid-refractory ITM in whom Mycobacterium tuberculosis (MTB) was suspected clinically and in whom other known causes of myelopathy were excluded. The study occurred from January 2003 to June 2010. Patients underwent trial chemotherapy with ATT. Efficacy was assessed by the American Spinal Injury Association (ASIA) scoring system, the Barthel Index (BI) and the Hauser Ambulation Index (AI) at baseline, 12 months, and 24 months, using magnetic resonance imaging (MRI). Of the 67 patients enrolled, 51 were assessed and 16 withdrew. At 24 months, 49 patients experienced benefits as indicated by significantly increased ASIA and BI scores. The Hauser AI index also improved with markedly decreased abnormal signals in spinal cord MRI over time. The results from this prospective study provide beneficial clinical and MRI data on the efficacy of ATT in ITM patients and suggests mycobacteria may be an important and neglected cause of myelitis.

Transverse Myelitis

“…Bacteria reported to cause PITM 155,195,[201][202][203][204][205][206][207][208][209][210][211][212][213][214] are listed in Box 5.…”

“…One noteworthy parasite is the pinworm (Enterobius vermicularis), which has been reported to cause TM associated with anti-GM1 antibodies (which are also seen in C jejuni infection) via molecular mimicry. 224 Pathogens associated with parainfectious LETM [167][168][169][170]186,192,193,201,209,212,213,[225][226][227][228][229][230][231][232][233][234][235][236][237][238][239] are listed in Box 3.…”

Striking Regression of Temporal Lobe Necrosis Following Radiotherapy for Nasopharyngeal Carcinoma in a Clinical trial of Anti-Mycobacterium Therapy

“…The absence of a sensitive laboratory test for CNS mycobacterium infection might lead to failure to detect this type of infection. 25 Although AMT is promising, there are still many risks during the treatment. Three patients initially responded to AMT therapy, but their condition deteriorated with continued therapy.…”

Infratentorial Tuberculoma Mimics Tumor in Immunocompetent Adults: An Analysis of 11 Patients

“…However, their diagnostic efficacy are usually be questioned by their specificity for distinguishing CNS TB from other CNS disease. Several other CNS diseases [10,20] had been found to be associated with mycobacteria infection over the past 3 years. Therefore neurologist should be aware of the limitations to the notion of "sensitivity and specificity" about MTB PCR tests.…”