Transverse myelitis associated with mycoplasma pneumoniae: case report

Abstract

SummaryAcute transverse myelitis (ATM) is a disorder of the spinal region of the central nervous system. In the present case, the clinical course showed ATM associated with mycoplasma pneumoniae (MP) and little recovery; the girl was left with a flaccid paraplegia, and thus differed from other cases in the literature which all reported complete or near complete recovery.

Acute Childhood Encephalitis andMycoplasma pneumoniae

“…pneumoniae has been implicated as a cause of immunemediated neurologic syndromes, including ADEM, transversemyelitis, and Guillain-Barré syndrome [12,36,[39][40][41][42][43][44][45][46]. In our cohort, ADEM was diagnosed in 2 children in whom M. pneumoniae was detected in the throat but not in the CSF by PCR.…”

Differential Diagnosis of Acute Flaccid Paralysis and its Role in Poliomyelitis Surveillance

“…As a cause of AFP, acute transverse myelitis is less frequent than Guillain-Barre syndrome or paralytic nonpolio enterovirus infection; the reported annual incidence is less than one case per 2 million population (104). The common presentation includes, in the initial phase of spinal shock, weakness of the lower extremities, AFP, urinary distention (neurogenic bladder), constipation, hyporeflexia, sensory impairment (sensory level), severe pain, and paresthesia.…”

Central nervous system manifestations of Mycoplasma pneumoniae infections

“…31,49,110,[116][117][118] Mild CSF pleocytosis and slightly increased protein may be seen in stroke cases. 57,59 Antibodies to M. pneumoniae in the CSF in addition to serum, are occasionally detected 89,90,[93][94][95][96]98,101,106 even in cases with atypical presentations, e.g. stroke.…”

“…8,10,13 Mild cognitive impairments have been described 3,16 but more severe neurologic consequences were noted in 20-60% of cases in large patient series. 6,8,10,12,16 Most reported patients with M. pneumoniae related ATM fully recovered after a variable period 39,90,94,100,105 with minor neurological injury left in a few cases 89,91,[95][96][97][98]100,101,104 and only rare fatalities. 88 On the contrary, M. pneumoniae related radiculitis and Guillain-Barre have been associated with a more severe course.…”

“…Several such reports were reviewed. 6,39,[86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105] Patients present with an acute motor disturbance that tends to progress rapidly 106 with loss of sphincter function and bilateral segmental sensory changes that cannot be attributed to medullary compression or systemic extraneural disease. The paralysis initially is flaccid but when persistent may evolve to spasticity.…”