title: Longitudinally extensive transverse myelitis as the sole presentation of neuro-Behçet's disease responding to infliximab.
abstract: BACKGROUND
  Isolated involvement of the spinal cord is an uncommon presentation of neuro-Behçet's disease (NBD) and it is associated with a poor prognosis for functional recovery.
  
  
  METHODS
  A case report of an 18-year-old Turkish man who presented with a progressive paraparesis and bladder dysfunction secondary to a longitudinally extensive transverse myelitis as the sole presentation of NBD.
  
  
  RESULTS
  Examination revealed a spastic paraparesis and a T7 sensory level. Magnetic resonance imaging revealed multiple enhancing lesions throughout the thoracic cord and cerebrospinal fluid showed intense neutrophilia. On further enquiry a family history of Behçet's disease was elicited. The patient subsequently reported a history of recurrent oral ulceration and intermittent occular inflammation. A diagnosis of NBD was made and intravenous high-dose steroids commenced with poor response. In view of the poor prognosis for functional recovery associated with spinal NBD the patient was treated with infliximab, an anti-tumour necrosis factor-alpha monoclonal antibody, leading to excellent recovery of function.
  
  
  CONCLUSIONS
  Early treatment with infliximab may facilitate a favourable functional recovery and should be considered in cases of NBD with spinal cord involvement.
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, Merseyside, UK. ian.coulter@doctors.org.uk
authors.forename: Ian
authors.initials: I
authors.lastname: Coulter
authors.forename: Saif
authors.initials: S
authors.lastname: Huda
authors.forename: Atik
authors.initials: A
authors.lastname: Baborie
authors.forename: Anu
authors.initials: A
authors.lastname: Jacob
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001528:Behcet Syndrome / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000069285:Infliximab; D008279:Magnetic Resonance Imaging; D008297:Male; D009188:Myelitis, Transverse / Q000150:complications / Q000188:drug therapy*; D013904:Thoracic Vertebrae / Q000473:pathology
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab