Rhombencephalitis With Long Segment Transverse Myelitis: A Presentation With a Rare Etiology

Rhombencephalitis is an inflammatory disease affecting the hindbrain (brainstem and cerebellum). The causes of rhombencephalitis can be divided into infections, autoimmune conditions, and paraneoplastic syndrome. Early onset rhombencephalitis is associated with demyelinating disorders or Epstein-Barr virus infection. Infections like Listeria and paraneoplastic disorders were seen in older individuals. Transverse myelitis includes pathobiological heterogeneous syndrome characterized by acute or subacute spinal cord dysfunction resulting in paraparesis, a sensory level, and autonomic (bladder, bowel, and sexual) impairment below the level. A lesion of the spinal cord where three or more vertebral segments are involved is called longitudinally extensive transverse myelitis (LETM). One of the most distinct causes of LETM is neuromyelitis optica spectrum disorder. Here, we describe a 34-year-old male who presented with quadriparesis, multiple cranial nerve palsies with sensory, bowel, and bladder involvement, along with altered sensorium with a preceding history of fever five days back. His magnetic resonance imaging (MRI) of the brain and spine was suggestive of rhombencephalitis with long-segment transverse myelitis. He later developed an intracranial hemorrhage during the hospital stay. His cerebrospinal fluid BioFire (BioFire Diagnostics, LCC, Salt Lake City, UT) was positive for herpes simplex virus 1.