Transverse Myelitis: A Case-Based Discussion of Infectious Etiologies
Divya Singh1, Gavin deFisser1, Sandra Samuel1
1Neurology, Saint Louis University School of Medicine, St. Louis, USA.
Abstract:
Transverse myelitis (TM) is a frequently encountered inpatient neurological condition, usually with a broad differential of etiologies narrowed down by detailed history, temporal profile of symptom evolution, and pertinent diagnostic studies. We report a rare case of a 39-year-old man who presented with subacute onset of headaches and confusion, and three days later developed quadriplegia and areflexia. He was diagnosed with acute longitudinally extensive transverse myelitis (LETM) related to Epstein-Barr virus (EBV) superimposed on an initial presentation of streptococcal meningitis. As both etiologies are under-reported, we compare our case to the few similar cases in the literature to guide discussion of the clinical and radiologic findings of parainfectious TM related to EBV and streptococcal meningitis. Readers will have the challenge of attributing our patient's myelitis to one of these parainfectious sources and are encouraged to evaluate for rare infectious etiologies in acute settings.
Insights
This case report details a rare instance of longitudinally extensive transverse myelitis (LETM) in a 39-year-old man, potentially linked to both Epstein-Barr virus (EBV) and streptococcal meningitis. The study highlights the diagnostic challenge in attributing myelitis to rare infectious causes.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Transverse myelitis (TM) is a neurological condition with diverse causes, requiring thorough investigation.
- Identifying the specific etiology of TM is crucial for appropriate patient management.
Observation:
- A 39-year-old man presented with headache and confusion, rapidly progressing to quadriplegia and areflexia.
- The patient was diagnosed with acute longitudinally extensive transverse myelitis (LETM).
Findings:
- The LETM was suspected to be parainfectious, potentially related to Epstein-Barr virus (EBV) infection.
- An initial presentation of streptococcal meningitis was also noted, complicating the etiological diagnosis.
- This case represents a rare co-occurrence of these conditions leading to TM.
Implications:
- This case underscores the importance of considering rare infectious etiologies in acute neurological presentations.
- Comparing this case with existing literature aids in understanding parainfectious TM related to EBV and meningitis.
- Further research is needed to elucidate the mechanisms and clinical spectrum of these rare TM causes.
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