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.

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.

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.

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.

Guillain–Barré syndrome, transverse myelitis and infectious diseases

Guillain–Barrésyndrome(GBS)and transverse myelitis(TM)both represent immunologically mediated polyneuropathies of major clinical importance.Both are thought to have a genetic predisposition,but as of yet no specific genetic risk loci have been clearly defined.Both are considered autoimmune,but again the etiologies remain enigmatic.Both may be induced via molecular mimicry,particularly from infectious agents and vaccines,but clearly host factor and co-founding host responses will modulate disease susceptibility and natural history.GBS is an acute inflammatory immune-mediated polyradiculoneuropathy characterized by tingling,progressive weakness,autonomic dysfunction,and pain.Immune injury specifically takes place at the myelin sheath and related Schwann-cell components in acute inflammatory demyelinating polyneuropathy,whereas in acute motor axonal neuropathy membranes on the nerve axon(the axolemma)are the primary target for immune-related injury.Outbreaks of GBS have been reported,most frequently related to Campylobacter jejuni infection,however,other agents such as Zika Virus have been strongly associated.Patients with GBS related to infections frequently produce antibodies against human peripheral nerve gangliosides.In contrast,TM is an inflammatory disorder characterized by acute or subacute motor,sensory,and autonomic spinal cord dysfunction.There is interruption of ascending and descending neuroanatomical pathways on the transverse plane of the spinal cord similar to GBS.It has been suggested to be triggered by infectious agents and molecular mimicry.In this review,we will focus on the putative role of infectious agents as triggering factors of GBS and TM.

飞行员急性脊髓炎一例

一、临床资料 患者，男性，47岁，民航飞行员，737机长教员，飞行时间15000h。患者于2006年1月21日上午无明显诱因出现双下肢麻木及发热，但可行走，未予重视，15：00飞行任务结束后出现胸痛，以双侧乳头平面明显，19：00出现双侧乳头平面以下对称性痛觉减退，双下肢无力，搀扶下可行走，伴排尿困难，无意识障碍、抽搐、头痛、头晕、恶心、呕吐。