Neuromyelitis optica and concomitant pulmonary tuberculosis: a case report 

Abstract

Background Concomitant diagnosis of neuromyelitis optica spectrum disease and pulmonary tuberculosis has rarely been reported. Case report We report a case involving a young Tunisian male patient who developed dry cough followed, 2 months later, by weakness in the lower limbs. The findings of central nervous system imaging and anti-aquaporin-4 antibody positivity were compatible with the diagnosis of neuromyelitis optica spectrum disease. Constellation of the clinical and the typical radiological pulmonary findings in our patient, coming from an endemic region, allowed the diagnosis of pulmonary tuberculosis, although sputum smear examination for acid-fast bacilli and cultures was negative. The patient received anti-tuberculous polytherapy associated with immunomodulation, consisting of methylprednisolone and intravenous immunoglobulins. Pulmonary infection symptoms initially improved but with no motor recovery. The patient suddenly died at home 4 months after the onset of the first symptoms. Current data regarding the clinical presentation of this underreported concomitant or associated condition, the possible pathophysiological mechanisms, and the therapeutic options were reviewed. Conclusions This case underscores the necessity to understand the exact mechanism of these coincident entities and to clarify the best immunomodulatory choice since immunosuppression targeting neuromyelitis optica spectrum disease can lead to dissemination of pulmonary tuberculosis.

Post COVID-19 infection neuromyelitis optica spectrum disorder (NMOSD): A case report-based systematic review

“…As reported in 2020 by Moghadasi, genetics and the environment are the main risk factors to cause NMOSD similar to MS and other demyelination disorders (Moghadasi, 2020). Parainfectious pathogenesis as an environmental risk factor could play a key role in triggering NMOSD, especially varicella-zoster virus (VZV) (Machado et al, 2015), mycobacterium pneumonia (Sellner et al, 2010), Epstein-Barr virus (EBV) (Bo et al, 2018), herpes simplex virus (HSV) (Nakamura et al, 2017), helicobacter (Eguchi et al, 2020), chlamydia pneumonia (Eguchi et al, 2020), zika (Brainer-Lima et al, 2021), cytomegalovirus (CMV) (Park et al, 2013), and tuberculosis (Saied et al, 2021).…”