Neurology Department, Mongi Ben Hmida National Institute of Neurology, University of Tunis El Manar, Jbel Lakhdhar Street 1007, LaRabta Bab Saâdoun, Tunis, Tunisia.
J Med Case Rep. 2021 Aug 6;15(1):391. doi: 10.1186/s13256-021-03002-1.
Concomitant diagnosis of neuromyelitis optica spectrum disease and pulmonary tuberculosis has rarely been reported.
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.
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.
视神经脊髓炎谱系疾病与肺结核同时诊断的情况很少见。
我们报告了一例年轻的突尼斯男性患者，他先出现干咳，2 个月后出现下肢无力。中枢神经系统影像学和抗水通道蛋白 4 抗体阳性的结果与视神经脊髓炎谱系疾病的诊断相符。来自流行地区的患者的临床和典型影像学肺部表现提示诊断为肺结核，尽管痰涂片抗酸杆菌检查和培养均为阴性。患者接受了抗结核多药联合免疫调节治疗，包括甲泼尼龙和静脉注射免疫球蛋白。肺部感染症状最初有所改善，但运动功能无恢复。患者在首发症状出现后 4 个月突然在家中死亡。我们对这种报道较少的同时或相关疾病的临床表现、可能的病理生理机制和治疗选择的现有数据进行了综述。
该病例强调了理解这些同时存在的实体的确切机制以及阐明最佳免疫调节选择的必要性，因为针对视神经脊髓炎谱系疾病的免疫抑制可能导致肺结核的播散。
