Unusual presentation of transverse myelitis due to bacterial meningitis: A case report

Abstract

BackgroundAcute transverse myelitis is a rare but severe inflammatory demyelinating disorder that usually involves the spinal cords’ sensory and motor tracts. The incidence of acute transverse myelitis (ATM) in children under the age of 16 years is estimated to be 2 per million per year based on studies in the UK and Canada. The most common location of transverse myelitis in children is the cervical region. PresentationA 5.5-year-old vaccinated male, a known case of Thalassemia major for 1 year of age, presented to the emergency department with complaints of fever and headache for 2 days, bilateral lower limb weakness and pain in the back for 1 day, and numbness in the lower limbs for 6 h. On examination, he was pale, irritable, and lethargic but fully conscious and oriented, with BP 105/62 mm Hg, PR 134 bpm, RR 29 b/min, temperature 37 °C, oxygen saturation 98% on room air, neurologically intact cranial nerves, normal speech and fundoscopy, significant neck stiffness, a positive Kernig's sign, normal trunk, and upper limbs, and flaccid paralysis of the lower limbs (power grade 0/5) with the loss of reflexes and all types of sensations in the lower limbs up to the thighs and mute plantars. A differential diagnosis of transverse myelitis or Guillain-Barré syndrome secondary to meningitis was made. Relevant laboratory investigations were ordered. Blood and cerebrospinal fluid culture showed no growth. The absence of cytoalbuminologic dissociation in the cerebrospinal fluid excluded Guillain-Barré syndrome. MRI (magnetic resonance imaging) of the brain and spinal cord was ordered to reach the final diagnosis. The MRI brain was normal, and the MRI spinal cord showed hyper intense T2 signals in the distal spinal cord from T11 to L1 vertebrae and the conus medullaris. Radiological differentials like acute disseminated encephalomyelitis and multiple sclerosis could easily be ruled out through clinical features. ConclusionWe demonstrated that bacterial meningitis could be complicated by spinal cord dysfunction, due to direct infection of the cord (myelitis). During the encounter with a meningitis patient, spinal cord lesions should be given prompt consideration because they have an unfavourable prognosis and can cause persistent neurologic defects of moderate to a marked degree if not managed timely.