Recurrent transverse myelitis following neurobrucellosis: immunologic features and beneficial response to immunosuppression.
The authors report the clinical course and immune system response of a patient with disease-associated recurrent transverse myelitis (TM) following cerebral infection with Brucellosis melitensis. The patient suffered four recurrences of his TM (each at a distinct spinal cord level) over the course of 2 years following his initial presentation, which ultimately progressed to quadriplegia. He had progressively declining cerebrospinal fluid (CSF) brucella antibody titers, suggesting a postinfectious, rather than an infectious, etiology. The authors simultaneously examined the expression of multiple cytokines in the CSF of this patient using cytokine antibody arrays and found a marked elevation of interleukin (IL)-6, IL-8, and macrophage chemoattractant protein (MCP)-1 levels relative to controls. Quantitative enzyme-linked immunosorbent assay (ELISA) analysis of the CSF confirmed a 1700-fold elevation of IL-6 and more modest elevations of IL-8 and MCP-1. IL-6 levels returned to baseline following treatment of the patient with intravenous cyclophosphamide and plasma exchange and the patient experienced a significant and sustained recovery of function.
Krishnan
Chitra
C
Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Kaplin
Adam I
AI
Graber
Jerome S
JS
Darman
Jessica S
JS
Kerr
Douglas A
DA
D000368:Aged; D002006:Brucellosis / Q000150:complications*; D018932:Chemokine CCL2 / Q000134:cerebrospinal fluid; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D015850:Interleukin-6 / Q000134:cerebrospinal fluid; D016209:Interleukin-8 / Q000134:cerebrospinal fluid; D008297:Male; D009188:Myelitis, Transverse / Q000188:drug therapy / Q000209:etiology / Q000276:immunology; D012008:Recurrence; D013116:Spinal Cord / Q000473:pathology; D016896:Treatment Outcome
D018932:Chemokine CCL2; D007166:Immunosuppressive Agents; D015850:Interleukin-6; D016209:Interleukin-8; D003520:Cyclophosphamide