Abstract
BackgroundA number of reports have described the presence of tuberculosis (TB) in neuromyelitis optica (NMO) patients. However, a definite association between the two conditions has not been conclusively demonstrated.MethodsTo investigate the association between NMO and TB in a Chinese population, we performed a retrospective review of hospital records of NMO patients, control patients and tuberculosis meningitis (TBM) patients from January 1, 1995 to December 31, 2011.ResultsThe frequency of preceding/simultaneous active pulmonary TB (PTB) was not significantly different between NMO patients (1.1%) and control groups (2.3% in myasthenia gravis, 1.1% in polymyositis or dermatomyositis, zero in idiopathic facial palsy and viral meningitis/meningoencephalitis). NMO cases differed from TBM cases in terms of demographics, course (recurrent or monophasic), cerebrospinal fluid analysis and magnetic resonance images. Two TBM patients shared partial clinical features with NMO (one of the TBM patients had a longitudinal extensive spinal cord lesion involving the holocord, and the other had optic neuritis before anti-tuberculosis treatment). NMO antibodies were only detected in NMO patients and not in TBM patients with myelitis or optic neuritis.ConclusionsWe could not confirm previous suggestions of the association between PTB and NMO. Direct infection of the central nervous system by TB may mimic NMO in some respects, but whether NMO-like symptoms that develop during the course of TB should be considered and diagnosed as NMO is open to discussion.
Highlights
A number of reports have described the presence of tuberculosis (TB) in neuromyelitis optica (NMO) patients
The single NMO patient who had a previous history of pulmonary TB (PTB) showed no evidence indicative of TB infection in the central nervous system (CNS)
She was a 26-year-old woman who experienced visual blurring simultaneously in bilateral optic neuritis and hemiplegia of her left limbs, 2 months prior to admission. She was positive for NMO-IgG and the cerebrospinal fluid (CSF) protein concentration was 0.67 g/L, while glucose concentration and cell count were normal
Summary
A number of reports have described the presence of tuberculosis (TB) in neuromyelitis optica (NMO) patients. A definite association between the two conditions has not been conclusively demonstrated. A study by Hughes and colleagues described three patients that developed acute necrotic myelopathy during the course of active pulmonary TB (PTB) [4]. An association between NMO and TB has been suggested in a number of reports from different geographical regions, a definite association between the two conditions has not been conclusively demonstrated. Further investigation and clarification would be helpful in the diagnosis and treatment of patients who develop ‘NMOlike’ symptoms (longitudinal extensive myelitis and optic neuritis) during the course of TB. We performed a retrospective study to investigate whether there is an association between NMO and TB in the Chinese population
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