Progressive quadriparesis and inflammation: A common disease, a rare presentation

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Disseminated tuberculosis can present with diverse neurological manifestations.
• Tuberculous arachnoiditis is a rare but serious complication of tuberculosis.

Observation:

• A previously healthy 10-year-old girl presented with progressive limb pain and weakness, fever, neck rigidity, and neurological deficits.
• Clinical presentation mimicked Landry-Guillain-Barré syndrome, with nerve conduction studies revealing demyelinating polyneuropathy.
• MRI revealed nerve root clumping in the conus and cauda equina, and CECT chest showed necrotic mediastinal lymph nodes.

Findings:

• The patient was diagnosed with disseminated tuberculosis and tuberculous arachnoiditis.
• Treatment included anti-tuberculosis therapy (ATT), pulse methylprednisolone, and oral corticosteroids.
• The patient achieved complete clinical recovery after 5 months of therapy.

Implications:

• Highlights the importance of considering tuberculosis in the differential diagnosis of unexplained neurological syndromes, especially in endemic areas.
• Emphasizes the effectiveness of early diagnosis and comprehensive treatment for tuberculous arachnoiditis.
• Demonstrates successful management of a rare neurological complication of disseminated tuberculosis in a pediatric patient.