Paraplegia episodes revealing tuberculous myelitis.

A 38 year-old woman, without previous medical history, presented, since 199 3, several paraplegic fits carrying herself progressively through to a seve re paraplegia. Diagnoses successively proposed were spinal cord compression s by slipped discs, spinal cord infarct and multiple sclerosis. In November 1998, the patient presented back pain and fever. Spinal cord magnetic reso nance imaging (MRI) revealed a mildly enlarged dorsal cord with signal abno rmalities. The lesions were isointense on TI-weighted images, hyperintense on T2-weighted images and showed a ringlike contrast enhancement A lumbar p uncture showed a trouble cerebrospinal fluid (CSF) with leucocytes 600/mm(3 ) (85 p. 100 polynuclear), protein 6.7 g/l, glucose 0.26g/l, chloride 109mm ol/l. The patient was first treated with parenteral unspecific antibiothera py Microbiological studies of blood and CSF were negative. CSF examination with polymerase chain reaction (PGR) was positive for Mycobacterium tubercu losis. Clinical (pain and fever) symptoms and CSF abnormalities decreased a fter antituberculous treatment However, paraparesis remain severe. Spinal t uberculous localizations often lead to diagnostic and therapeutic errors. i mprovement of spinal cord MRI sequences and using of PCR technics in CSF wo uld contribute to reduce these difficulties.