Tuberculous meningitis complicated with thoracic cord myelitis; a diagnostic conundrum

Tuberculosis is known as the great masquerader for its ability to present atypically. We report a case of a young man presented with progressive tuberculous meningitis and subsequently developed paraplegia due to thoracic cord myelitis, where diagnosis was confirmed bacteriologically. We highlight t...

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Published inSri Lanka journal of medicine (Online) Vol. 30; no. 1; pp. 132 - 137
Main Authors Shantha, D. W. A., Yasaratne, D., Ralapanawa, D. M. P. U. K., Jayalath, T., Abeyagunawardena, S., Dissanayake, D. M. P. K., Jayawardana, W. J. B. S. M. S.
Format Journal Article
LanguageEnglish
Published The Kandy Society of Medicine 01.07.2021
Subjects
intravenous immunoglobulin
tuberculous meningitis
tuberculous myelitis
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Summary:Tuberculosis is known as the great masquerader for its ability to present atypically. We report a case of a young man presented with progressive tuberculous meningitis and subsequently developed paraplegia due to thoracic cord myelitis, where diagnosis was confirmed bacteriologically. We highlight the presence of acute gastric dilatation as a warning sign of thoracic cord involvement and the place for CSF examination and spinal imaging in arriving at a clinical diagnosis, as treatment needs to start without delay to avoid permanent sequelae. Patient showed a good response to a combined approach of anti-tuberculosis treatment, systemic steroids and intravenous immunoglobulin.
ISSN:2579-1990
2579-1990
DOI:10.4038/sljm.v30i1.264