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Acute transverse myelitis is an inflammatory disorder of the spinal cord, characterized by acute or subacute onset of paraparesis, bilateral sensory deficit, and impaired sphincter function. Also characteristic are a spinal segmental sensory level and the lack of clinical or laboratory evidence of spinal cord compression.Mycobacterium tuberculosis is a very rare cause of transverse myelitis. An abnormal activation of the immune system against the spinal cord is thought to be the main etiologic mechanism. Other suspected mechanisms are the direct invasion by the bacillus and the toxic effect of antituberculous drugs.Diagnosis is achieved through the patient's medical history and the analysis of cerebrospinal fluid, magnetic resonance imaging of the spinal cord, and bacteriological confirmation of tuberculous infection.We present a patient with acute transverse myelitis secondary to miliary tuberculosis who had marked clinical improvement and neurologic recovery after treatment of tuberculosis and intravenous steroid pulses. (Clin Pulm Med 2005;12: 46 -52)A cute transverse myelitis (ATM) is an inflammatory disorder of the spinal cord, characterized by acute or subacute onset of paraparesis, bilateral sensory deficit and impaired sphincter function, and a spinal segmental sensory level but no clinical or laboratory evidence of spinal cord compression. 1 The estimated incidence is 1 to 5 cases per million individuals a year. 2,3 ATM of an infectious origin corresponds to 35% to 45% of cases, 2,3 and the frequency is higher in patients under 40 years of age. ATM associated with tuberculosis is extremely rare, and the main etiologic mechanism is supposed to be an abnormal activation of the immune system against the spinal cord. 4 We present a patient with ATM and miliary tuberculosis. CASE REPORTA 48-year-old female patient presented with lower limb weakness and fever that began 30 days before admission. These symptoms progressed to paraplegia and anesthesia. A week before hospitalization, she had acute urinary retention. Physical examination revealed lower limb areflexia, sensory level at T11, hyperreflexia in the upper limbs, and mild left facial paresis. The patient reported that her husband had undergone complete treatment of pulmonary tuberculosis 7 years before.Chest radiograph revealed bilateral small nodular opacities (Fig. 1). Laboratory tests upon admission showed hemoglobin 11.8 g/dL; erythrocyte sedimentation rate 53 mm/h; aspartate aminotransferase 56 UI/L (normal below 35 UI/L); alanine aminotransferase 86 UI/L (normal below 35 UI/L); ␥-glutamyl transpeptidase 278 UI/L (normal below 33 UI/L); alkaline phosphatase 306 UI/L (normal below 240 UI/L); albumin 2.85 g/dL.Magnetic resonance imaging (MRI) of the dorsolumbar spine showed an abnormal signal at the dorsal level with diffuse hyperintensity on T2-weighted images and signal alteration of the medullary conus, with absence of myeloradicular compressions (Fig. 2). MRI of the brain showed multiple nodular images in supra-and infratentorial encephalic parenc...

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