Mohmed Mohmed Hussien Ahmed, Idrees Isra Hamed Dafallah, Mostafa Ahmed, Ibrahim Khalid Elfatih Mohammed, Ahmad Amna Adnan, Daoud Mahmoud H S
Faculty of Medicine, Gezira University, Madani, Sudan.
Madani Teaching Hospital, Madani, Sudan.
AME Case Rep. 2025 Jun 6;9:76. doi: 10.21037/acr-24-211. eCollection 2025.
Tuberculous myelitis is a form of central nervous system tuberculosis (TB) that can be associated with intracranial involvement but rarely presents with extensive longitudinal involvement of more than one segment. We are reporting a case with tuberculous meningitis and long-segment myelitis in a previously undiagnosed patient with TB.
A 53-year-old hypertensive male, presented with subacute lower limbs weakness, sensory level below his nipples, and urine retention. Erythrocyte sedimentation rate (ESR) was above 112 mm/hour. Magnetic resonance imaging (MRI) spine showed a long segment of hyperintense signal seen on the T2-weighted image (T2WI) images in the spinal cord extending from C6 to D3 vertebral segments, with heterogeneous post-contrast enhancement. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis with high protein and low glucose, and polymerase chain reaction (PCR) for (MBTB) was positive. The patient received intravenous methylprednisolone daily for 5 days and standard anti-TB medications [rifampicin, isoniazid (INH), pyrazinamide, and ethambutol] for 12 months. However, repeated CSF analysis 3 months after starting anti-TB medications showed a negative PCR for MBTB, normal cell count, and glucose with slightly elevated protein. Still, the patient did not show any clinical improvement.
Long-segment tuberculous myelitis (LSTM) is a rare form of central nervous system TB that can be accompanied by tuberculous meningitis. It must be considered a differential diagnosis of neuromyelitis optica spectrum disorder (NMOSD), especially in endemic areas of TB, as the management approach is completely different.
结核性脊髓炎是中枢神经系统结核病的一种形式，可伴有颅内受累，但很少出现超过一个节段的广泛纵向受累。我们报告一例既往未诊断出结核病的患者出现结核性脑膜炎和长节段脊髓炎的病例。
一名53岁的高血压男性，表现为亚急性下肢无力、乳头以下感觉平面及尿潴留。红细胞沉降率（ESR）高于112毫米/小时。脊柱磁共振成像（MRI）显示脊髓T2加权像（T2WI）上从C6至D3椎体节段有一长节段高信号，增强扫描呈不均匀强化。脑脊液（CSF）分析显示淋巴细胞增多，蛋白高、葡萄糖低，结核分枝杆菌（MTB）聚合酶链反应（PCR）阳性。患者接受了5天的静脉注射甲泼尼龙治疗，并接受了12个月的标准抗结核药物治疗[利福平、异烟肼（INH）、吡嗪酰胺和乙胺丁醇]。然而，开始抗结核药物治疗3个月后重复进行的脑脊液分析显示MTB的PCR为阴性，细胞计数正常，葡萄糖正常，蛋白略有升高。尽管如此，患者仍未显示出任何临床改善。
长节段结核性脊髓炎（LSTM）是中枢神经系统结核病的一种罕见形式，可伴有结核性脑膜炎。必须将其视为视神经脊髓炎谱系障碍（NMOSD）的鉴别诊断，尤其是在结核病流行地区，因为治疗方法完全不同。
