Devic's neuromyelitis optica associated with active pulmonary tuberculosis, Tunisia

Zayet, Souheil; Zaghdoudi, Aida; Harrabi, H.; Goubantini, A.

doi:10.1016/j.nmni.2020.100828

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Thus, activated MTB is more likely to invade the spinal cord or meninges in patients with neurosyphilis. It is widely accepted that TB can coexist with other immune or infectious diseases such as HIV infection, neurosyphilis, cryptococcal meningitis, and NMO[ 19 - 21 ]. Gonzales Zamora et al [ 21 ] have reported a case of neurosyphilis with concomitant cryptococcal and tuberculous meningitis in a patient with AIDS.…”

Section: Discussionmentioning

confidence: 99%

“…Gonzales Zamora et al [ 21 ] have reported a case of neurosyphilis with concomitant cryptococcal and tuberculous meningitis in a patient with AIDS. Zayet et al [ 19 ] also found a case of concurrent Devic’s neuromyelitis optica associated with active pulmonary TB. However, there are no reports of tuberculous myelitis in patients with neurosyphilis.…”

Section: Discussionmentioning

confidence: 99%

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Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

Gu¹,

Tian²,

Yan³

2021

WJCC

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

Gu¹,

Tian²,

Yan³

2021

WJCC

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“…Whether there is pain or not, recurrent ON in a MOG-IgG antibody-positive patient is characterized as chronic relapsing inflammatory optic neuritis (CRION), which is another subtype of ON. [ 24 ] Sarcoidosis [ 25 , 26 , 27 , 28 ] with or without uveitis and lung involvement, tuberculosis [ 23 ][ 24 ][ 25 , 26 , 27 , 28 ][ 29 ][ 30 ][ 31 ] , and syphilis [ 32 , 33 , 34 ] are less frequent etiologies.…”

Section: Introductionmentioning

confidence: 99%

Acute Optic Neuritis: An Update on Approach and Management

Jamali Dogahe,

Pakravan,

Pakravan

2023

JOVR

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This review discusses the physical examination and diagnostic tests necessary to diagnose optic neuritis (ON) and provides an update on the approach and management of acute ON. A comprehensive search of the PubMed database was conducted, limited to English-language journals and recent publications. A total of 160 articles were initially screened by title, of which 73 articles were included in the narrative synthesis. ON is an inflammation of the optic nerve that can be caused by different systemic and neurological disorders. It is commonly presented as a subacute unilateral painful vision loss, and based on its clinical manifestation, it can be classified as typical or atypical. Atypical ON is bilateral with visual acuity of worse than 20/200 or has an atypical demographic presentation for demyelination, such as a non-Caucasian male with optic disc swelling, for which neuromyelitis optica spectrum disorder (NMOSD), myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), or other etiologies should be considered. Steroids and immunosuppressants are the main treatment options for ON, and timely treatment initiation is critical to preventing irreversible vision loss, especially in atypical cases.

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“…Rigdon, in 1947, described a case of tuberculous myelitis in a patient with tuberculous meningitis [4]. In many cases, neuromyelitis optica spectrum disease (NMOSD), an autoimmune inflammatory disease affecting the central nervous system, has been described in association with pulmonary tuberculosis or central nervous system tuberculosis [5][6][7][8]. In a retrospective analysis done in India, Synmon, and colleagues, reported that approximately 19% of longitudinal extensive myelitis (LETM) cases were associated with either pulmonary or meningeal tuberculosis [9].…”

Section: Introductionmentioning

confidence: 99%

Tuberculous myelitis: a prospective follow-up study

et al. 2022

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Background Prospective studies regarding tuberculous myelitis are lacking. We aimed to prospectively evaluate patients with tuberculous myelitis to identify the features that distinguish tuberculous myelitis from other myelitis. Methods This was a prospective study. Patients presenting with paraparesis/quadriparesis, and MRI showing myelitis were included. All patients were subjected to clinical, neuroimaging, and laboratory evaluation. Diagnosis of definite tuberculous myelitis was made if GeneXpert test in CSF was positive. Probable tuberculous myelitis was diagnosed if there was evidence of tuberculosis elsewhere in the body. Patients were treated with methylprednisolone and antituberculosis treatment. Patients were followed for 6 months. We compared the clinical, laboratory, and neuroimaging parameters and response to treatment of tuberculous myelitis with other myelitis. P values were adjusted using the Benjamini-Hochberg (BH) procedure to control false discovery rate. ResultsWe enrolled 52 patients. Eighteen (34.6%) patients had tuberculous myelitis. Headache (P = 0.018) was significantly more common in tuberculous myelitis. The CSF protein (P < 0.001), and CSF cell count (P < 0.001) were significantly higher in tuberculous myelitis. On neuroimaging, a LETM was common in tuberculous myelitis. Spinal meningeal enhancement (14; 77.8%), extra-axial collection, and CSF loculation (6; 33.4%), arachnoiditis (3;16.7%), and concomitant spinal tuberculoma (2;11.1%) were other common imaging features of tuberculous myelitis. Tuberculous myelitis patients showed a better response (P = 0.025) to treatment. Conclusion Tuberculous myelitis was seen in approximately 35% of all myelitis cases, in a high tuberculosis endemic zone. Headache, markedly elevated CSF protein and spinal meningeal enhancement were distinguishing features. Tuberculous myelitis patients responded well to corticosteroids.

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Devic's neuromyelitis optica associated with active pulmonary tuberculosis, Tunisia

Cited by 5 publications

References 10 publications

Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

Acute Optic Neuritis: An Update on Approach and Management

Tuberculous myelitis: a prospective follow-up study

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