Abuzneid Yousef S, Al-Janazreh Hamdi, Haif Motasem, Idais Shahd T, Asakrah Baraa, Ajwa Sufana M, Sarahneh Shifa, Abdeen Hani
Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine.
Hematology Department and Bone Marrow Transplant Unit, Cancer Care Center, Augusta Victoria Hospital, Jerusalem, State of Palestine.
Ann Med Surg (Lond). 2021 Aug 18;69:102728. doi: 10.1016/j.amsu.2021.102728. eCollection 2021 Sep.
Transverse myelitis is a rare spinal cord inflammation with absence of a compression. It varies in presentation based on the pathology location, and mainly causes a combined deficit of motor, sensory, and autonomic functions. History, physical examination, and other diagnostic tests including blood tests and an MRI are important tools to establish a diagnosis.A thorough neurological evaluation helps localize the affected region of the spinal cord. The management includes rehabilitation as any other spinal cord injury. If very severe, a multidisciplinary rehabilitation program will be required.
We explain a case in which a 43-year-old male patient, known to have chronic myelogenous leukemia (CML), on Imatinib (a tyrosine kinase inhibitor), started complaining of back pain at the level of the 10th rib. Different tests were made including a PET-CT (Positron Emission Tomography-Computed Tomography) which showed hypermetabolic bony lytic lesion in the left mandible at the level of temporomandibular joint, destruction of the 10th rib, and no evidence of spinal cord compression. Other etiologies were excluded, making transverse myelitis due to radiation for the patient's CML on top of the differential diagnosis.
A thorough physical examination and diagnostic tests are important tools to exclude other etiologies of complex neurological deficit in a patient with CML.
横贯性脊髓炎是一种罕见的脊髓炎症，不存在压迫情况。其临床表现因病理位置而异，主要导致运动、感觉和自主神经功能的联合缺损。病史、体格检查以及包括血液检查和磁共振成像（MRI）在内的其他诊断测试是确立诊断的重要工具。全面的神经学评估有助于定位脊髓的受影响区域。治疗包括与其他脊髓损伤一样的康复治疗。如果病情非常严重，则需要多学科康复计划。
我们阐述了一个病例，一名43岁男性患者，已知患有慢性粒细胞白血病（CML），正在服用伊马替尼（一种酪氨酸激酶抑制剂），开始抱怨第10肋水平处的背痛。进行了包括正电子发射断层扫描 - 计算机断层扫描（PET - CT）在内的不同检查，结果显示颞下颌关节水平的左下颌骨有高代谢骨溶解性病变、第10肋破坏，且无脊髓受压证据。排除了其他病因，在鉴别诊断中，该患者因CML放疗导致的横贯性脊髓炎位列其中。
全面的体格检查和诊断测试是排除CML患者复杂神经功能缺损其他病因的重要工具。
