Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

Abstract

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.

Tuberculous meningomyelitis: Report of a case

“…Tuberculous meningomyelitis often presents with a TB history or contact [2]. This disease is caused by invasion of the spinal cord or the spinal meninges due to hematogenous spread [2,3]. The most common clinical symptoms are urinary and intestinal symptoms (urinary retention and urinary and bowel incontinence) (90%), fever (70%), and paraplegia (60%) [3].…”

“…Early evidence for TB-M includes lymphocytic pleocytosis and normal or low glucose levels on CSF and a positive IGRA test [4]. Central nervous system infarctions, communicating hydrocephalus and basal meningeal, and spinal cord enhancement on post-contrast are common findings in MRI [3,[5][6][7].…”