Mycobacterial meningomyelitis associated with human immunodeficiency virus infection

A homosexual man, seropositive for human immunodeficiency virus, developed back and leg pain that evolved, over three weeks, into a T-10 anesthetic, areflexic paraplegia. Spinal fluid examination showed lymphocytosis, markedly elevated spinal fluid protein, and hypoglycorrhachia. A spinal cord biopsy specimen disclosed an intramedullary granuloma containing acid-fast bacilli. The patient was treated with antituberculous drugs and had no progression of neurologic deficit. He died, eight months after first becoming ill, of Klebsiella pyelonephritis and septicemia. Mycobacterial meningomyelitis is presently the only known acquired immunodeficiency syndrome-related myelopathy responsive to specific treatment.