title: Intramedullary tuberculosis manifested as Brown-Sequard syndrome in a patient with systemic lupus erythematosus.
abstract: A 25-year-old girl presented with progressive deterioration of right side weakness with decreased sensation on the left trunk. She had been treated with high dose steroid due to autoimmune thrombocytopenia for 2 months. Clinical, laboratory and immunologic studies revealed that she had systemic lupus erythematosus (SLE), MRI of spinal cord showed marginal contrast enhancing and fluid containing mass in the cord of the C5-6 level, suggesting intramedullary abscess. She underwent surgery of mass removal with biopsy. The pathologic findings from cord tissues revealed numerous acid fast bacilli (AFB) in necrotic tissues. After surgery and anti-tuberculous treatment, her neurologic symptoms were markedly improved with restoration of right side motor weakness. To our knowledge, this is the first case report of intramedullary tuberculosis in a patient with SLE. Since intramedullary tuberculosis may sometimes mimic neurologic complication of SLE itself, it may pose diagnostic and therapeutic confusion for clinicians. We report a case of spinal cord tuberculosis affecting C5, 6 level which was manifested as Brown-Sequard syndrome in a patient with SLE.
authors.affiliation: Research Center in Catholic Medical Center, Kang-Nam St. Mary's Hospital, Department of Internal Medicine, Seoul, Korea.
authors.forename: W U
authors.initials: WU
authors.lastname: Kim
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
authors.forename: B Y
authors.initials: BY
authors.lastname: Shim
authors.forename: J K
authors.initials: JK
authors.lastname: Min
authors.forename: Y S
authors.initials: YS
authors.lastname: Hong
authors.forename: S H
authors.initials: SH
authors.lastname: Park
authors.forename: C S
authors.initials: CS
authors.lastname: Cho
authors.forename: C K
authors.initials: CK
authors.lastname: Park
authors.forename: H Y
authors.initials: HY
authors.lastname: Kim
mesh_terms: D000328:Adult; D001706:Biopsy; D018437:Brown-Sequard Syndrome / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy; D013116:Spinal Cord / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use; D014399:Tuberculosis, Spinal / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology
chemical_list: D013256:Steroids