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Peer-reviewedCC BY-NC-ND 4.0The American Journal of Case Reports

Tuberculosis-Associated Longitudinally Extensive Transverse Myelitis

  • Habib Behjatnia1
  • Antonio Crespo1
  • Cody Davis2
  • Jonathan Ruiz3
  • Bryan Velasco4
  • Joselin Navas1
  • Stephen J. Carlan5
5 affiliations
  1. 1Department of Infectious Diseases, Orlando Regional Healthcare System, Orlando, FL, USA
  2. 2Department of Critical Care Medicine, Orlando Regional Healthcare System, Orlando, FL, USA
  3. 3Department of Internal Medicine, Orlando Regional Healthcare System, Orlando, FL, USA
  4. 4Department of Neurology, Orlando Regional Healthcare System, Orlando, FL, USA
  5. 5Department of Academic Affairs and Research, Orlando Regional Healthcare System, Orlando, FL, USA
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Abstract

Patient: Male, 51-year-old

Final Diagnosis: Tuberculosis-associated longitudinally extensive transverse myelitis

Symptoms: Chronic non-productive cough • fevers • headache

Clinical Procedure: —

Specialty: Infectious Diseases

Objective: Rare disease

Background: Longitudinally extensive transverse myelitis (LETM) involves a continuous inflammatory lesion that spans 3 or more spinal segments. It is a recognized but rare manifestation of Mycobacterium tuberculosis infection.

Case Report: A 51-year-old man originally from Mexico with a significant past medical history presented with altered mental status. He had a 1-year history of a chronic non-productive cough and approximately 20 days of fevers and headaches. Upon admission, he was encephalopathic without neurological deficits, and his Glasgow Coma Scale score was 11. A non-contrast computed tomography (CT) scan of the head was initially negative for pathology. Shortly after admission, he developed respiratory distress and worsening mental status, ultimately requiring intubation. A repeat non-contrast CT scan showed concern for hydrocephalus. An external ventricular drain was inserted into the right lateral ventricle, and cerebrospinal fluid (CSF) samples obtained from the drain were unremarkable. The patient underwent bronchoscopy with bronchoalveolar lavage, and the samples sent for Mycobacterium tuberculosis polymerase chain reaction testing were positive. He remained unresponsive. Magnetic resonance imaging (MRI) of the brain and spine was negative for obstruction but revealed diffuse leptomeningeal enhancement across multiple areas, consistent with extensive inflammatory longitudinal transverse myelitis, possibly secondary to pulmonary Mycobacterium tuberculosis infection. Ultimately, the CSF was negative for autoimmune or paraneoplastic processes but showed elevated inflammatory markers. He was treated with high-dose glucocorticoids, plasmapheresis, and anti-tuberculosis therapy. He remained intubated with only moderate improvement and was discharged after 2 months.

Conclusions: Tuberculous-associated LETM should be considered in patients with active pulmonary tuberculosis who develop a concomitant inflammatory myelopathy.

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Cite

BibTeXRIS
BibTeX
@article{behjatnia2026tuberculosisassociated,
  title = {{Tuberculosis-Associated Longitudinally Extensive Transverse Myelitis}},
  author = {Habib Behjatnia and Antonio Crespo and Cody Davis and Jonathan Ruiz and Bryan Velasco and Joselin Navas and Stephen J. Carlan},
  journal = {The American Journal of Case Reports},
  year = {2026},
  month = oct,
  doi = {10.12659/ajcr.953701},
  url = {https://doi.org/10.12659/ajcr.953701},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Tuberculosis-Associated Longitudinally Extensive Transverse Myelitis
AU  - Habib Behjatnia
AU  - Antonio Crespo
AU  - Cody Davis
AU  - Jonathan Ruiz
AU  - Bryan Velasco
AU  - Joselin Navas
AU  - Stephen J. Carlan
PY  - 2026
DA  - 2026/10/22
JO  - The American Journal of Case Reports
DO  - 10.12659/ajcr.953701
UR  - https://doi.org/10.12659/ajcr.953701
AB  - Patient: Male, 51-year-old  Final Diagnosis: Tuberculosis-associated longitudinally extensive transverse myelitis  Symptoms: Chronic non-productive cough • fevers • headache  Clinical Procedure: —  Specialty: Infectious Diseases  Objective: Rare disease  Background: Longitudinally extensive transverse myelitis (LETM) involves a continuous inflammatory lesion that spans 3 or more spinal segments. It is a recognized but rare manifestation of Mycobacterium tuberculosis infection.  Case Report: A 51-year-old man originally from Mexico with a significant past medical history presented with altered mental status. He had a 1-year history of a chronic non-productive cough and approximately 20 days of fevers and headaches. Upon admission, he was encephalopathic without neurological deficits, and his Glasgow Coma Scale score was 11. A non-contrast computed tomography (CT) scan of the head was initially negative for pathology. Shortly after admission, he developed respiratory distress and worsening mental status, ultimately requiring intubation. A repeat non-contrast CT scan showed concern for hydrocephalus. An external ventricular drain was inserted into the right lateral ventricle, and cerebrospinal fluid (CSF) samples obtained from the drain were unremarkable. The patient underwent bronchoscopy with bronchoalveolar lavage, and the samples sent for Mycobacterium tuberculosis polymerase chain reaction testing were positive. He remained unresponsive. Magnetic resonance imaging (MRI) of the brain and spine was negative for obstruction but revealed diffuse leptomeningeal enhancement across multiple areas, consistent with extensive inflammatory longitudinal transverse myelitis, possibly secondary to pulmonary Mycobacterium tuberculosis infection. Ultimately, the CSF was negative for autoimmune or paraneoplastic processes but showed elevated inflammatory markers. He was treated with high-dose glucocorticoids, plasmapheresis, and anti-tuberculosis therapy. He remained intubated with only moderate improvement and was discharged after 2 months.  Conclusions: Tuberculous-associated LETM should be considered in patients with active pulmonary tuberculosis who develop a concomitant inflammatory myelopathy.
SN  - 1941-5923
ER  -