Longitudinally extensive transverse myelitis associated with scrub typhus:A case report

Rationale:Longitudinally extensive transverse myelitis(LETM)is a rare inflammatory demyelinating disease predominantly associated with autoimmune and inflammatory disorders.Scrub typhus can cause a variety of neurological complications,which may result in poor recovery and long-term disability.This report reveals a rare linkage between LETM and scrub typhus.Patient concerns:A 24-year-old female presented with a history of fever for 10 days associated with progressive quadriparesis.Physical examination revealed bilateral lower limb weakness(grade 0/5)and bilateral upper limb weakness(grade 2/5)with reduced sensation below the T3 dermatome.Diagnosis:Scrub typhus presenting with longitudinally extensive transverse myelitis.Interventions:Steroid pulse therapy with antibiotics supported by early intensive rehabilitation.Outcomes:Complete recovery was achieved.Lessons:This case report highlights the importance of considering scrub typhus as a potential cause of LETM in endemic regions,particularly in patients presenting with febrile illness and neurological symptoms.

Acute Transverse Myelitis in Pregnancy—A Case Report and a Literature Review

Purpose: This case report highlights a rare instance of a 26-week pregnant woman presenting with limb numbness, diagnosed with acute transverse myelitis (ATM) following COVID-19 vaccination. Notably, she tested positive for neuromyelitis optica (NMO) but did not exhibit the typical symptoms of blurred vision. Methods: Data were collected from I Seha in governmental hospitals in Bahrain, providing a comprehensive overview of the patient’s clinical journey. Results: The patient was treated with carbamazepine, steroids, and clexane, leading to the successful delivery of a healthy baby at 34 weeks. However, two years postpartum, she reported new episodes of blurred vision and numbness. Subsequent treatment with Rituximab resulted in significant improvement, with a diagnosis of Devic’s disease established. Conclusion: Acute transverse myelitis is a rare condition, particularly during pregnancy, and in this case, symptoms of Devic’s disease were masked by the absence of blurred vision. This condition predominantly affects females in their 20s during childbearing years and can lead to complications such as premature delivery. Effective management includes steroids and antiepileptic drugs, with clexane playing a crucial role in preventing embolisms. A delivery mode may vary based on obstetric factors, and MRI remains the gold standard for diagnosis. Close follow-up is essential for optimal patient outcomes.

Influence of ganglioside combined with methylprednisolone sodium succinate on efficacy and neurological function in patients with acute myelitis

BACKGROUND Acute myelitis(AM)can lead to sudden sensory,motor and autonomic nervous dysfunction,which negatively affects their daily activities and quality of life,so it is necessary to explore optimization from a therapeutic perspective to curb the progression of the disease.AIM To investigate the effect of ganglioside(GM)combined with methylprednisolone sodium succinate(MPSS)on the curative effect and neurological function of patients with AM.METHODS First,we selected 108 AM patients visited between September 2019 and September 2022 and grouped them based on treatment modality,with 52 patients receiving gamma globulin(GG)+MPSS and 56 patients receiving GM+MPSS,assigned to the control group(Con)and observation group(Obs),respectively.The therapeutic effect,neurological function(sensory and motor function scores),adverse events(AEs),recovery(time to sphincter function recovery,time to limb muscle strength recovery above grade 2,and time to ambulation),inflammatory factors(IFs)[interleukin(IL)-6,C-reactive protein(CRP),and tumor necrosis factor(TNF)-α]and other data of the two groups were collected for evaluation and comparison.RESULTS The Obs had:(1)A significantly higher response rate of treatment than the Con;(2)Higher scores of sensory and motor functions after treatment that were higher than the baseline(before treatment)and higher than the Con levels;(3)Lower incidence rates of skin rash,gastrointestinal discomfort,dyslipidemia,osteoporosis and other AEs;(4)Faster posttreatment recovery of sphincter function,limb muscle strength and ambulation;and(5)Markedly lower posttreatment IL-6,CRP and TNF-αlevels than the baseline and the Con levels.CONCLUSION From the above,it can be seen that GM+MPSS is highly effective in treating AM,with a favorable safety profile comparable to that of GG+MPSS.It can significantly improve patients’neurological function,speed up their recovery and inhibit serum IFs.

A Case of Acute Upper Gastrointestinal Bleeding in Liver Cirrhosis Complicated by Acute Cerebral Infarction and Acute Myelitis

Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.

Clinical characteristics, pathogenesis, treatment and prognosis of osteomyelitis in children: a retrospective study from a single center

Osteomyelitis is a common musculoskeletal infection in children,and the acute and chronic osteomyelitis are the two most common type.Acute osteomyelitis affects about 1 in every 5,000 to 10,000 people and is more common in developing countries and economically disadvantaged areas.

Transverse myelitis caused by herpes zoster following COVID-19 vaccination:A case report

BACKGROUND Transverse myelitis(TM)is characterized by sudden lower extremity progressive weakness and sensory impairment,and most patients have a history of advanced viral infection symptoms.A variety of disorders can cause TM in association with viral or nonviral infection,vascular,neoplasia,collagen vascular,and iatrogenic,such as vaccination.Vaccination has become common through the global implementation against coronavirus disease 2019(COVID-19)and reported complications like herpes zoster(HZ)activation has increased.CASE SUMMARY This is a 68-year-old woman who developed multiple pustules and scabs at the T6-T9 dermatome site 1 wk after vaccination with the COVID-19 vaccine(Oxford/AstraZeneca([ChAdOx1S{recombinant}]).The patient had a paraplegia aggravation 3 wk after HZ symptoms started.Spinal magnetic resonance imaging(MRI)showed transverse myelitis at the T6–T9 Level.Treatment was acyclovir with steroids combined with physical therapy.Her neurological function was slowly restored by Day 17.CONCLUSION HZ developed after COVID-19 vaccination,which may lead to more severe complications.Therefore,HZ treatment itself should not be delayed.If neurological complications worsen after appropriate management,an immediate diagnostic procedure,such as magnetic resonance imaging and laboratory tests,will start and should treat the neurological complications.

Clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging

BACKGROUND Syphilitic myelitis caused by Treponema pallidum is an extremely rare disease. However, symptomatic neurosyphilis, especially syphilitic myelitis, and its clinical features have been infrequently reported. Only a few cases of syphilitic myelitis have been documented. To the best of our knowledge, there are only 19 reported cases of syphilitic myelitis. However, the clinical features of syphilitic myelitis with longitudinally extensive myelopathy have been still not clear. AIM To explore the clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging (MRI). METHODS First, we report a patient who suffered from syphilitic myelitis with symptoms of sensory disturbance, with longitudinally extensive myelopathy with "flip-flop sign" on spinal MRI. Second, we performed a literature search to identify other reports (reviews, case reports, or case series) from January 1987 to December 2018, using the PubMed and Web of Science databases with the terms including "syphilis","neurosyphilis","syphilitic myelitis","meningomyelitis","central nervous system", and "spine". We also summarized the clinical features of syphilitic myelitis with longitudinally extensive myelopathy. RESULTS A total of 16 articles of 20 cases were identified. Sixteen patients presented with the onset of sensory disturbance (80%), 15 with paraparesis (75%), and 9 with urinary retention (45%). Eleven patients had a high risk behavior (55%). Five patients had concomitant human immunodeficiency virus infection (25%).Serological data showed that 15 patients had positive venereal disease research laboratory test (VDRL)/treponema pallidum particle agglutination (TPHA), and 17 had positive VDRL/TPHA in cerebrospinal fluid (CSF). Seventeen patients were found to have elevated leukocytosis and protein in CSF. On MRI, 16 patients showed abnormal hyperintensities involved the thoracic spine, 6 involved the cervical spine, and 3 involved both the cervical and thoracic spine. There were 3 patients with the "flip-flop sign". All the patients were treated with penicillin, and 15 patients had a good prognosis. CONCLUSION Our case further raises awareness of syphilitic myelitis as an important complication of neurosyphilis due to homosexuality, especially in developing countries such as China.

Rituximab in neuromyelitis optica: A review of literature

Neuromyelitis optica spectrum disorders, or neuromyelitis optica(NMO), is an autoimmune disease of the central nervous system that must be distinguished from multiple sclerosis. Therapeutic approaches to relapse prevention in NMO include immunosuppressants and monoclonal antibodies. Rituximab, a monoclonal antibody that targets CD20 antigen expressed on the surface of pre-B, mature B-lymphocytes and a small subset of T-lymphocytes, has been widely used for the treatment of NMO. In this review, we aim to summarize global experience with rituximab in NMO. We identified 13 observational studies that involved a total of 209 NMO patients treated with rituximab. Majority of rituximab-treated patients evidenced stabilization or improvements in their disability scores compared to pre-treatment period and 66% of patients remained relapse-free during treatment period. Monitoring rituximab treatment response with CD19+ or CD27+ cell counts appears to improve treatment outcomes. We offer clinical pointers on rituximab use for NMO based on the literature and authors' experience, and pose questions that would need to be addressed in future studies.

Multiple sclerosis and neuromyelitis optica spectrum disorders：some similarities in two distinct diseases

Neuromyelitis optica spectrum disorder（NMOSD）is a chronic inflammatory disorder of the central nervous system that particularly involves the optic nerve and spinal cord.It is pathologically characterized by astrocytopathy,followed by tissue destruction（Fujihara,2011）.Historically,NMOSD has been considered to be an Asian optic-spinal form of multiple sclerosis（MS）,

Varicella-zoster virus-associated meningitis,encephalitis,and myelitis with sporadic skin blisters:A case report

BACKGROUND Varicella-zoster virus(VZV)generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves.Virus reactivation owing to an impaired immune system causes inflammation along spinal nerves from the affected spinal segment,leading to skin manifestations(herpes zoster).Viremia and subsequent hematogenous transmission and nerve axonal transport of the virus may lead to meningitis,encephalitis,and myelitis.One such case is described in this study.CASE SUMMARY A 64-year-old man presented with dysuria,pyrexia,and progressive disturbance in consciousness.He had signs of meningeal irritation,and cerebrospinal fluid(CSF)analysis revealed marked pleocytosis with mononuclear predominance and a CSF/serum glucose ratio of 0.64.Head magnetic resonance imaging revealed hyperintense areas in the frontal lobes.He had four isolated blisters with papules and halos on his right chest,right lumbar region,and left scapular region.Infected giant cells were detected using the Tzanck test.Degenerated epidermal cells with intranuclear inclusion bodies and ballooning degeneration were present on skin biopsy.Serum VZV antibody titers suggested previous infection,and the CSF tested positive for VZV-DNA.He developed paraplegia,decreased temperature perception in the legs,urinary retention,and fecal incontinence.The patient was diagnosed with meningitis,encephalitis,and myelitis and was treated with acyclovir for 23 days and prednisolone for 14 days.Despite gradual improvement,the urinary retention and gait disturbances persisted as sequelae.CONCLUSION VZV reactivation should be considered in differential diagnoses of patients with sporadic blisters and unexplained central nervous system symptoms.

Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis:A case report

BACKGROUND Tuberculous myelitis is a rare manifestation of tuberculosis(TB)that is usually caused by hematogenous spread of Mycobacterium tuberculosis(MTB).Neurosyphilis is a neurological disease that occurs when Treponema pallidum invades the brain or the spinal cord.Individually,these two diseases involving the spinal cord are rare and cases of concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis have seldom been reported.CASE SUMMARY A 56-year-old man presented with numbness and pain of both lower limbs for 2 wk and dysuria for 1 wk.Syphilis serology and cerebrospinal fluid(CSF)analysis supported the diagnosis of neurosyphilis and the patient was treated with intravenous ceftriaxone at first,but symptoms still progressed.Then,magnetic resonance images revealed multiple lesions along the cervicothoracic junction,and chest computed tomography showed a typical TB lesion.MTB DNA was detected in the CSF sample by metagenomic next-generation sequencing.Eventually the patient was diagnosed with tuberculous myelitis combined with asymptomatic neurosyphilis.Subsequently,quadruple anti-TB drug standardized therapy was empirically used and his neurological symptoms improved gradually.CONCLUSION Patients can have coinfection with tuberculous transverse myelitis and asymptomatic neurosyphilis.Patients with neurosyphilis should be examined for other pathogens.

Correlation between serum uric acid levels and clinical characteristics in patients with longitudinally extensive transverse myelitis A case-control study

Uric acid is reduced in demyelinating diseases, including multiple sclerosis and neuromyelitis optica （NMO）. Longitudinally extensive transverse myelitis （LETM） is often an early manifestation of NMO. Whether uric acid levels are reduced at presentation of LETM remains unknown. The present study investigated serum uric acid levels by evaluating 35 patients with LETM, 64 with NMO, 62 with multiple sclerosis, 63 with other neurological diseases and 65 healthy controls. In addition, we tested the correlation between serum uric acid and the clinical characteristics of LETM. All patients were in the acute phase, defined as less than 1 month from onset or relapse. The results revealed that serum uric acid levels in LETM were significantly lower than in multiple sclerosis, other neurological diseases and healthy controls, but no difference was found between LETM and NMO. A negative correlation between uric acid levels and Expanded Disability Status Scale scores was found in LETM patients （r = -0.545, P 〈 0.05）. The results suggest that uric acid levels are reduced in patients with LETM, raising the possibility that lower uric acid levels are an indicator of disease disability. Moreover, reduced uric acid levels may be a risk factor in NMO.

Transverse myelitis after infection with varicella zoster virus in patient with normal immunity: A case report

BACKGROUND Varicella zoster virus(VZV)is a human neurotropic and double-stranded DNA alpha-herpes virus.Primary infection with VZV usually occurs during childhood,manifesting as chickenpox.Reactivation of latent VZV can lead to various neurological complications,including transverse myelitis(TM);although cases of the latter are very rare,particularly in newly active VZV infection.CASE SUMMARY We report here an unusual case of TM in a middle-aged adult immunocompetent patient that developed concomitant to an active VZV infection.The 46-year-old male presented with painful vesicular eruption on his left chest that had steadily progressed to involvement of his back over a 3-d period.Cerebrospinal fluid testing was denied,but findings from magnetic resonance imaging and collective symptomology indicated TM.He was administered antiviral drugs and corticosteroids immediately but his symptom improvement waxed and waned,necessitating multiple hospital admissions.After about a month of repeated treatments,he was deemed sufficiently improved for hospital discharge to home.CONCLUSION VZV myelitis should be suspected when a patient visits the outpatient pain clinic with herpes zoster showing neurological symptoms.

缺血性脊髓病的临床和影像学特征分析

目的总结缺血性脊髓病的临床和影像学特征。方法选取2015—2023年被误诊为急性脊髓炎,并于首都医科大学宣武医院最终确诊为缺血性脊髓病患者5例,回顾性分析患者的临床资料,总结患者的临床症状和影像学特点。结果5例患者中,男2例、女3例,中位发病年龄59岁,均为急性起病,表现为肢体无力、麻木等脊髓损害症状。5例患者的脊髓MRI示髓内异常信号,其中颈髓病变4例、腰膨大病变1例;轴位影像均出现典型“蛇眼征”特点5例,其中2例患者矢状位影像表现为“铅笔征”。患者发病早期应用免疫治疗后效果不佳。入院明确诊断后,给予抗凝或抗血小板药物治疗及脊髓功能康复治疗,症状有不同程度改善,但由于治疗延迟,均遗留肢体无力或麻木症状。结论脊髓髓内异常信号的特殊征象“蛇眼征”和“铅笔征”可作为缺血性脊髓病和急性脊髓炎的影像学重要鉴别要点。应提高以急性起病的脊髓损害症状患者特殊影像学征象的识别能力。

新型冠状病毒感染后脊髓炎的临床演变和不典型脊髓影像学特点分析

目的分析新型冠状病毒感染后脊髓炎的临床演变过程及不典型脊髓MRI特点。方法回顾性分析4例新型冠状病毒感染后脊髓炎患者的临床表现、病程演变和脊髓MRI动态变化特点及治疗转归。结果4例患者起病时间分别为新冠感染后5 d、15 d、80 d和30 d,首发症状为双下肢麻木无力3例、背部疼痛伴双下肢无力1例,高峰期症状包括截瘫、括约肌功能障碍、感觉障碍平面、痉挛性步态,神经功能状况评估量表(EDSS)评分分别为7.5分、9.0分、9.0分、7.5分。初始脊髓MRI无病灶1例,线状脊膜强化1例,T2点状病灶2例;高峰期T2为点片状、线状、云雾状病灶,横断面主要累及侧索和后索,突出特点为病程中均出现过线状脊膜强化和临床症状大于影像学表现。4例患者中2例予甲泼尼龙冲击联合血浆置换治疗未见明显好转,4例患者均遗留明显残疾。结论新型冠状病毒感染后脊髓炎临床多表现为典型的脊髓炎症状,但脊髓影像学可表现为片状、线状、云雾状病灶,伴线状脊膜强化。新冠感染后脊髓炎的迟发性和不典型的脊髓MRI表现值得关注。

1例颅内动脉瘤术后发热患者的抗感染治疗分析

本文报道临床药师参与1例颅内动脉瘤患者术后发热的抗感染治疗经过。患者初期为蛛网膜下腔出血导致的发热,属于非感染性发热。之后出现颅内感染,根据临床相关指南及抗菌药物血脑屏障通透性,优化万古霉素及美罗培南静脉给药方案。后期脑脊液培养提示大肠埃希菌,降阶梯使用头孢他啶,患者颅内感染治愈。住院期间患者出现脱髓鞘性脊髓炎不良事件,考虑与庆大霉素鞘内给药单次剂量过大有关,及时停用鞘内给药方案,最终患者肌力恢复良好。治疗过程中,临床药师协助医师制定并优化个体化治疗方案,为患者安全、有效使用抗菌药物提供参考。

Cytomegalovirus Transverse Myelitis Secondary to Influenza Infection and Early Recovery:A Case Report

Immunosuppression can lead to opportunistic infections in a host.The evidence of viral infections causing immunosuppression in a host for a transient period is gaining attention.In order to prolong their stay in the human body,viruses affect the human immune systemin various ways.Common viral infections such as influenza can lead to transient lymphocytopenia,which lays the groundwork for more dangerous opportunistic infections.Cytomegalovirus(CMV)infection is a rare cause of inflammatory myelopathy.We present the case of a patient with an influenza infection who progressed to severe acute respiratory distress syndrome,methicillin-resistant Staphylococcus aureus necrotizing pneumonia,and idiopathic lymphocytopenia with a CD4 count of 61 perμL on arrival.After 2 weeks,the patient developed complete flaccid paralysis with sensory and autonomic dysfunction.Because his polymerase chain reaction results of cerebrospinal fluid and blood test were positive for CMV infection,he was treated with high doses of steroids and ganciclovir intravenously.Due to early diagnosis and intervention,the patient was able to recover in 2 months with only minimal residual weakness.Thus,this case stresses on the importance of looking out for opportunistic infections in patients affected by severe viral infections for their early recovery.

Ocular tuberculosis associated with Epstein-Barr virus myelitis: A case report

Ocular tuberculosis(OTB)is a chronic eye infection caused by Mycobacterium tuberculosis.Some cases of myelitis are associated with Epstein-Barr virus(EBV),with 1-5%of EBV infections leading to neurologic complications.We describe a 34-year-old Iranian woman with OTB and EBV coinfection.Despite initial success with anti-TB agents,the disease progressed,necessitating enucleation.Mycobacterium tuberculosis was detected by a tuberculin coagulation test,and EBV was confirmed via polymerase chain reaction.MRI showed plaques in the spinal cord and brain.The patient was treated with anti-TB and antiretroviral agents.Recognizing TB in the differential diagnosis of EBV myelitis is crucial.

Role of autoreactive Tc17 cells in the pathogenesis of experimental autoimmune encephalomyelitis

Background:The pathogenesis of multiple sclerosis(MS)and experimental autoimmune encephalomyelitis(EAE-an animal model of MS)is primarily mediated by T cells.However,recent studies have only focused on interleukin(IL)-17-secreting CD4^(+)T-helper cells,also known as Th17 cells.This study aimed to compare Th17 cells and IL-17-secreting CD8^(+)T-cytotoxic cells(Tc17)in the context of MS/EAE.Methods:Female C57BL/6 mice were immunized with myelin oligodendrocyte glycoprotein peptides 35-55(MOG35-55),pertussis toxin,and complete Freund's adjuvant to establish the EAE animal model.T cells were isolated from the spleen(12-14 days postimmunization).CD4^(+)and CD8^(+)T cells were purified using isolation kit and then differentiated into Th17 and Tc17,respectively,using MOG35-55 and IL-23.The secretion levels of interferon-(IFN-γ)and IL-17 were measured via enzyme-linked immunosorbent assay using cultured CD4^(+)and CD8^(+)T cell supernatants.The pathogenicity of Tc17 and Th17 cells was assessed through adoptive transfer(tEAE),with the clinical course assessed using an EAE score(0-5).Hematoxylin and eosin as well as Luxol fast blue staining were used to examine the spinal cord.Purified CD8^(+)CD3^(+)and CD4^(+)CD3^(+)cells differentiated into Tc17 and Th17 cells,respectively,were stimulated with MOG35-55 peptide for proliferation assays.Results:The results showed that Tc17 cells(15,951±19855VS.55,709±4196cpm;p<0.050)exhibited a weaker response to highest dose(20μg/mL)MOG35-55 than Th17 cells.However,this response was not dependent on Th17 cells.After the 48h stimulation,at the highest dose(20μg/mL)of MOG35-55.Tc17 cells secreted lower levels of IFN-(280.00±15.00vs.556.67±15.28pg/mL,p<0.050)and IL-17(102.67±5.86 pg/mL vs.288.33±12.58 pg/mL;p<0.050)than Th17 cells.Similar patterns were observed for IFN-γsecretion at 96 and 144h.Furthermore,Tc17 cell-induced tEAE mice exhibited similar EAE scores to Th17 cell-induced tEAE mice and also showed similar inflammation and demyelination.Conclusion:The degree of pathogenicity of Tc17 cells in EAE is lower than that of Th17 cells.Future investigation on different immune cells and EAE models is warranted to determine the mechanisms underlying MS.

利妥昔单抗联合甲泼尼龙在脊髓炎患者中的临床疗效及对趋化因子和炎症因子的影响

目的:探讨利妥昔单抗联合甲泼尼龙在脊髓炎患者中的临床疗效及对趋化因子和炎症因子的影响。方法:选取164例脊髓炎患者为研究对象,按照治疗方式不同将患者分为对照组和观察组,每组各82例。对照组仅接受利妥昔单抗治疗;观察组在此基础上联合使用甲泼尼龙治疗,治疗后对患者治疗效果进行评估,比较两组生存质量、趋化因子[嗜酸性粒细胞趋化因子1(Eot1);嗜酸性粒细胞趋化因子2(Eot2);嗜酸性粒细胞趋化因子3(Eot3)]水平及炎症因子[白细胞介素6(IL-6)、IL-8、肿瘤坏死因子α(TNF-α)]水平。结果:治疗后,两组生存质量各维度评分均升高(P<0.05),且观察组高于对照组(P<0.05)。治疗后,两组Eot1、Eot2、Eot3水平均降低(P<0.05),且观察组低于对照组(P<0.05);两组IL-6、IL-8、TNF-α水平均降低(P<0.05),且观察组低于对照组(P<0.05)。结论:利妥昔单抗联合甲泼尼龙在脊髓炎患者中应用具有显著疗效,可明显改善患者趋化因子水平,调节炎症因子水平,改善患者的生存质量,获得良好的治疗预后,值得推广应用。