Longitudinally Extensive Transverse Myelitis with Mycobacterium Tuberculosis Infection

Abstract

Background: Often encompassing three or more spinal segments, longitudinally extensive transverse myelitis (LETM) is a severe inflammatory disease of the spinal cord. The clinical presentation, pathophysiological processes, and therapeutic results in LETM connected to tuberculosis were investigated in this research. Methods: 140 patients diagnosed with LETM linked with Mycobacterium Tuberculosis (MTB) participated in this cross-sectional study carried out at Gomal Medical College, Dera Ismail Khan, Pakistan, between April 2023 and August 2024. The sample size was calculated using the WHO sample size calculator using the non-probability consecutive sampling technique. MRI results and cerebrospinal fluid (CSF) analysis, including Ziehl-Neelsen staining and cultures, formed the basis for diagnosis. Results: Most often reported presenting symptoms were limb weakness 109(78%), sensory impairments 91(65%), and tiredness 70(50%). MRI showed 140(100%) of patients’ spinal cord abnormalities extending three or more segments. Early start of anti-tuberculosis treatment (within 3.5 ± 1.2 days) was strongly correlated with enhanced recovery; forty percent of patients attained complete recovery and forty-five percent partial recovery (p-value <0.05). Conclusion: Early diagnosis and appropriate start of corticosteroids and anti-tuberculosis treatment greatly enhanced LETM related to tuberculosis. Reduced prognoses linked to risk factors, including HIV co-infection and delayed therapy, highlighted the importance of fast and forceful care.