Clinically confirmed tuberculous radiculomyelitis: a case report
DOI:
https://doi.org/10.31117/neuroscirn.v8i4.421Keywords:
Spinal tuberculosis, CSF biomarkers in tuberculous radiculomyelitis, Guillain-Barré mimic, RadiculomyelitisAbstract
Tuberculous radiculomyelitis (TBRM) is a rare complication of tuberculosis which affects the nervous system. Common symptoms associated with TBRM include paraparesis or quadriparesis, urinary retention or constipation, and paraesthesia in the lower extremities. The ascending symptoms are often described as similar to Guillain Barre syndrome. A 21-year-old woman experienced progressive weakness from her lower to upper extremities, which eventually led to complete immobility within two days and was accompanied by autonomic dysfunction. Lumbar puncture demonstrated yellow and clear cerebrospinal fluid (CSF) with pleocytosis (214 cells/uL), neutrophil predominance (81%), increased protein (429mg/dL), and decreased CSF/serum glucose ratio (7 mg/dL vs. 159.3 mg/dL). Cervicothoracic MRI examination revealed multifocal hyperintense lesions with indistinct borders at the T5-T12 level and central predominance. These results indicate tuberculosis as the aetiology. This case illustrates the atypical manifestations of TB within the nervous system. In highly endemic countries like Indonesia, TB should be considered as one of the potential causes in the differential diagnosis of any progressive weakness involving the nervous system. The limited availability of high-sensitivity diagnostic tests for detecting Mycobacterium tuberculosis in the central nervous system remains a significant challenge.
Downloads
References
Alkan, O., Yildirim, T., Tokmak, N., & Tan, M. (2009). Spinal MRI findings of Guillain-Barré syndrome. Journal of Radiology Case Reports, 3(3), 25–28. https://doi.org/10.3941/jrcr.v3i3.153
Alomatu, S., Vasaikar, S., Thomas, K., Dubula, T., & Moeketsi, K. (2023). The efficiency of TB LAM antigen test to Xpert MTB/RIF Ultra test for the diagnosis of tuberculous pericarditis using pericardial fluid samples. Pathogens, 12(9), 1175. https://doi.org/10.3390/pathogens12091175
Chen, W., Huang, L., Tang, Q., Wang, S., Hu, C., & Zhang, X. (2020). Progress on diagnosis and treatment of central nervous system tuberculosis. Radiology of Infectious Diseases, 7(4), 160–169. https://doi.org/10.1016/j.jrid.2020.07.005
Dai, S., Ganiem, A. R., & van Laarhoven, A. (2021). Central nervous system tuberculosis. Current Opinion in Neurology, 34(3), 396–402. https://doi.org/10.1097/WCO.0000000000000920
Dalai, S. P., Kabi, S., Arve, N. R., & Kakollu, V. R. (2019). Tubercular meningitis with acute inflammatory demyelinating polyneuropathy—Trigger or chance. Journal of Neurosciences in Rural Practice, 10(3), 545–547. https://doi.org/10.1055/s-0039-1697567
Dydyk, A. M., & Singh, P. (2024). Radicular back pain. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546593/
Garg, D., Radhakrishnan, D. M., Agrawal, U., Vanjare, H. A., Gandham, E. J., & Manesh, A. (2023). Tuberculosis of the spinal cord. Annals of Indian Academy of Neurology, 26(2), 112–126. https://doi.org/10.4103/aian.aian_578_22
Gopalaswamy, R., Dusthackeer, V. N. A., Kannayan, S., & Subbian, S. (2021). Extrapulmonary tuberculosis—An update on the diagnosis, treatment and drug resistance. Journal of Respiration, 1(2), 141–164. https://doi.org/10.3390/jor1020015
Gundamraj, S., & Hasbun, R. (2020). The use of adjunctive steroids in central nervous infections. Frontiers in Cellular and Infection Microbiology, 10, 592017. https://doi.org/10.3389/fcimb.2020.592017
Gupta, M., Tobin, E. H., & Munakomi, S. (2025). CNS tuberculosis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/sites/books/NBK585138/
Kalscheuer, R., Palacios, A., Anso, I., Cifuente, J., Anguita, J., Jacobs, W. R., Jr, Guerin, M. E., & Prados-Rosales, R. (2019). The Mycobacterium tuberculosis capsule: A cell structure with key implications in pathogenesis. Biochemical Journal, 476(14), 1995–2016. https://doi.org/10.1042/BCJ20190324
Katrak, S. M. (2021). Central nervous system tuberculosis. Journal of the Neurological Sciences, 421, 117278. https://doi.org/10.1016/j.jns.2020.117278
Leonard, J. M. (2017). Central nervous system tuberculosis. Microbiology Spectrum, 5(2). https://doi.org/10.1128/microbiolspec.tnmi7-0044-2017
Li, W., Liu, Z., Xiao, X., Xu, Z., Sun, Z., Zhang, Z., & Wang, X. (2021). Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia. BMC Musculoskeletal Disorders, 22(1), 213. https://doi.org/10.1186/s12891-021-04078-y
Mancuso, G., Midiri, A., De Gaetano, S., Ponzo, E., & Biondo, C. (2023). Tackling drug-resistant tuberculosis: New challenges from the old pathogen Mycobacterium tuberculosis. Microorganisms, 11(9), 2277. https://doi.org/10.3390/microorganisms11092277
Moule, M. G., & Cirillo, J. D. (2020). Mycobacterium tuberculosis dissemination plays a critical role in pathogenesis. Frontiers in Cellular and Infection Microbiology, 10, 65. https://doi.org/10.3389/fcimb.2020.00065
Navarro-Flores, A., Fernandez-Chinguel, J. E., Pacheco-Barrios, N., Soriano-Moreno, D. R., & Pacheco-Barrios, K. (2022). Global morbidity and mortality of central nervous system tuberculosis: A systematic review and meta-analysis. Journal of Neurology, 269(7), 3482–3494. https://doi.org/10.1007/s00415-022-11052-8
Prapruttam, D., Hedgire, S. S., Mani, S. E., Chandramohan, A., Shyamkumar, N. K., & Harisinghani, M. (2014). Tuberculosis-the great mimicker. Seminars in ultrasound, CT, and MR, 35(3), 195–214. https://doi.org/10.1053/j.sult.2014.02.002
Prasad, K., Singh, M. B., & Ryan, H. (2016). Corticosteroids for Managing Tuberculous Meningitis. Cochrane Database of Systematic Reviews, 4(4), CD002244. https://doi.org/10.1002/14651858.CD002244.pub4
Rath, J., Zulehner, G., Schober, B., Grisold, A., Krenn, M., Cetin, H., & Zimprich, F. (2021). Cerebrospinal fluid analysis in Guillain-Barré syndrome: value of albumin quotients. Journal of Neurology, 268(9), 3294–3300. https://doi.org/10.1007/s00415-021-10479-9
Saxena, D., Pinto, D. S., Tandon, A. S., & Hoisala, R. (2021). MRI findings in tubercular radiculomyelitis. eNeurologicalSci, 22, 100316. https://doi.org/10.1016/j.ensci.2021.100316
Schutz, C., Davis, A. G., Sossen, B., Lai, R. P., Ntsekhe, M., Harley, Y. X. & Wilkinson, R. J. (2018). Corticosteroids as an adjunct to tuberculosis therapy. Expert Review of Respiratory Medicine, 12(10), 881–891. https://doi.org/10.1080/17476348.2018.1515628
Tai, M. S., Nor, H. M., Viswanathan, S., Rahmat, K., Mohd Zain, N. R., Pow, Z. Y., Ong, L. S., Rafia, M. H. & Tan, C. T. (2017). Spinal tuberculous disease is common in tuberculous meningitis. Neurology Asia, 22(24), 313–323.
Wen, L., Li, M., Xu, T., Yu, X., Wang, L., & Li, K. (2019). Clinical features, outcomes and prognostic factors of tuberculous meningitis in adults worldwide: Systematic review and meta-analysis. Journal of Neurology, 266(12), 3009–3021. https://doi.org/10.1007/s00415-019-09523-6
World Health Organization. (2014). Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis: Annex 2, Weight-based dosing for adults. https://www.ncbi.nlm.nih.gov/books/NBK247416/
World Health Organization. (2025). WHO operational handbook on tuberculosis: Module 4: Treatment and care. https://tbksp.who.int/en/node/3011
World Health Organization. (2024). Global tuberculosis report 2024. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Mohammad Kurniawan, Tiara Kasih, David Pangeran, Kartika Maharani
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The observations and associated materials published or posted by NeurosciRN are licensed by the authors for use and distribution in accord with the Creative Commons Attribution license CC BY-NC 4.0 international, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
