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Longitudinally-extensive transverse myelitis in the setting of recent Mycoplasma infection: Case series
Kyra Curtis1, Erin Hendry2, Zachary Christensen2
1University of Rochester Medical Center, Department of Neurology, USA.
Abstract:
Longitudinally-extensive transverse myelitis (LETM) is a rare but serious inflammatory myelopathy, often presenting with broad neurological symptoms with numerous possible etiologies that pose diagnostic and therapeutic challenges. Here we report three pediatric cases of aggressive LETM with recent Mycoplasma pneumoniae (M. pneumoniae) infection. All patients presented with rapid-onset lower extremity weakness and varying degrees of sensory changes and autonomic dysfunction. MRI confirmed extensive and expansile spinal cord lesions in each case. While M. pneumoniae throat nucleic acid amplification test (NAAT) was positive in all cases, CSF PCR was negative in two (and not performed in the third), raising the question of causality. Treatment regimens and functional outcomes varied, where one patient experienced persistent paraplegia. These cases highlight the potential association between M. pneumoniae and LETM, the diagnostic challenges posed by overlapping infectious and autoimmune features, and the need for early, aggressive treatment. Further research is needed to clarify the pathogenesis of this condition in order to optimize treatment and patient outcomes.
Insights
This study reports three pediatric cases of aggressive longitudinally-extensive transverse myelitis (LETM) linked to Mycoplasma pneumoniae infection. Early, aggressive treatment is crucial for managing this rare myelopathy and improving patient outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Longitudinally-extensive transverse myelitis (LETM) is a severe inflammatory myelopathy with diverse causes.
- LETM presents diagnostic and therapeutic challenges due to varied neurological symptoms.
Purpose of the Study:
- To report pediatric cases of aggressive LETM associated with Mycoplasma pneumoniae infection.
- To highlight diagnostic challenges and emphasize the need for timely, aggressive treatment.
Main Methods:
- Case series of three pediatric patients with LETM and recent M. pneumoniae infection.
- Clinical presentation, MRI findings, diagnostic test results (NAAT, CSF PCR), and treatment outcomes were analyzed.
Main Results:
- All patients had rapid-onset weakness, sensory changes, and autonomic dysfunction.
- MRI revealed extensive spinal cord lesions; M. pneumoniae throat NAAT was positive in all.
- Causality was questioned due to negative CSF PCR in two cases; one patient had persistent paraplegia.
Conclusions:
- Mycoplasma pneumoniae infection may be associated with aggressive pediatric LETM.
- Overlapping infectious and autoimmune features complicate diagnosis.
- Early, aggressive treatment is essential for optimizing outcomes in LETM.
