Neuromyelitis optica and pulmonary tuberculosis: a case-control study

Abstract

Neuromyelitis optica (NMO), or Devic's disease, is a rare acute inflammatory disease characterised by demyelination affecting the spinal cord and optic nerves. Although NMO usually occurs in isolation, the association between NMO and active pulmonary tuberculosis (TB) has been suggested by a number of case reports and series. To investigate the possible association between NMO and TB. A retrospective case-control study. We included adult patients admitted to our institution with a nal diagnosis of NMO based on accepted criteria between January 1995 and February 2011. Controls were hospital-based and consisted of patients admitted with a diagnosis of Guillain-Barré syndrome. Fourteen patients met the inclusion criteria, of whom 11 (79%) had a preceding or simultaneous diagnosis of pulmonary TB (PTB). The diagnosis of PTB preceded the onset of NMO by a median time of 4 weeks (range 0-12). Two of the controls were diagnosed with PTB. The odds ratio for the presence of active PTB in the NMO group vs. the control group was 4.6 (95%CI 1.71-15.49). These results indicate an association be- tween NMO and PTB in our population. The most likely mechanism is immune-mediated inflammatory demyelination of the optic nerves and spinal cord triggered by pulmonary infection with Mycobacterium tuberculosis.