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CASE REPORT
Year : 2021  |  Volume : 10  |  Issue : 2  |  Page : 1057-1060

Tubercular longitudinally extensive transverse myelitis (LETM): An enigma for primary care physicians


1 Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
2 Assistant Professor, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
3 Associate Professor, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
4 Professor and Head of the Department, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
5 Professor, Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India

Correspondence Address:
Dr. Ritwik Ghosh
Resident, Department of General Medicine; MRI Department, Beside Department (Falguni Nirman Private Limited), Burdwan Medical College and Hospital, Burdwan, West Bengal, PIN 713 104
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_2101_20

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Albeit, all forms of tuberculosis (TB) are endemic in India, spinal intramedullary TB and tubercular longitudinally extensive transverse myelitis (LETM) is deemed extremely rare. With recent advances in the field of neurology, autoimmune astrocytopathy (neuromyelitis optica spectrum disorders, NMOSD), myelin-oligodendrocyte glycoprotein associated encephalomyelitis (MOG-EM), metabolic myelopathy, connective tissue diseases and viral infections have gained considerable focus in the list of differentials of LETM whereas tubercular association is often forgotten. This report presents a rare case of acute transverse myelopathy which unveiled previously undiagnosed pulmonary tuberculosis in an adult rural Indian male. The patient responded well to anti-tubercular therapy and corticosteroids. Exact pathogenesis of LETM in TB remains elusive. Association of TB with MOG-EM has been one of the recent hot-cakes. However, an ill-defined immune-inflammatory response to the infectious agent is the likely cause of tubercular LETM. Hence, the primary care physicians who are the first medical contacts of acute LETM cases and in most cases due to diagnostic dilemma there is an unavoidable delay in accurate diagnosis and initiation of therapy. Primary care doctors should nurture a high index of suspicion to diagnose this potentially lifetime-debilitating yet absolutely treatable clinical condition i.e. tubercular LETM.


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