Transverse myelitis after lumbar steroid injection in a patient with Behcet's disease

Abstract

Study design: Case report. Objective: We describe a patient who developed transverse myelitis (TM) following a nerve root injection of steroids and anesthetic at L2 for radicular pain. Setting: Baltimore, MD, USA. Clinical presentation: A 42-year-old woman developed progressive lower extremity weakness and paresthesias, a T12 sensory level and urinary urgency 8 h following the injection of Marcaine and Celestone into the left L2 nerve root. Magnetic resonance imaging showed T2 signal abnormality with gadolinium enhancement from T12 to the conus medullaris and there was no evidence of traumatic injury to the spinal cord. The patient had undiagnosed Behcet's disease (BD) and had experienced multiple episodes of pathergy: hyper-responsiveness of the skin to local trauma, resulting in inflammation and edema. Intravenous steroids were initiated and the patient experienced a near total clinical resolution and a complete radiologic resolution. Conclusion: Since the spinal cord inflammation developed after and immediately adjacent to local spinal trauma, we suggest that the TM in this patient was related to BD and was a pathergy response in the spinal cord.Spinal Cord (2005) 43, 735-737.

Transverse Myelitis

“…106,107,[109][110][111][112][113][114] An unusual report of TM (extending from T9 to the conus) following CT-guided L2 nerve root injection, may be a florid demonstration of the pathergic reaction in the spinal cord. 115 Brain MRI may reveal T1-hypo/isointense and T2-hyperintense lesions that may or may not show gadolinium enhancement acutely. Characteristically, an upper pontomesencephalic lesion with thalamic, hypothalamic, and basal ganglial extension on one side is seen.…”

A case of neuro-Behcet's disease presenting with lumbar spinal cord involvement

“…3 The prevalence of spinal cord involvement in NBD patients ranges from 2.5 to 30%, and a predilection for cervical and thoracic involvements has been widely noted. 1,2 A case of NBD presenting as transverse myelitis from T9 to the conus after local spinal needle puncture was reported by Deshpande et al, 4 but the puncture procedure may have been the reason for the induced pathergy of spinal cord and might have caused the neurological involvement.…”

Acute inflammatory myelopathies

“…Of these 7 patients the myelitis was partial in 3, transverse in 2, and presented as a Brown-Séqard syndrome in 2. In addition to this series a number of case reports describe myelopathic involvement in Behçet's disease (Morrissey et al, 1993a;Yoshioka et al, 1996;Mascalchi et al, 1998;Kocer et al, 1999;Green and Mitchell, 2000;Harmouche et al, 2000;Lee et al, 2001;Lannuzel et al, 2002;Moskau et al, 2003;Calguneri et al, 2005;Deshpande et al, 2005;Mullins et al, 2009;Fukae et al, 2010;Metreau-Vastel et al, 2010). Behçet's associated myelitis is typically longitudinally extensive and extension of upper cervical cord lesions into brainstem structures can occur.…”