title: Tuberculous radiculomyelitis presenting as urinary retention in a child with Down's syndrome.
abstract: Tuberculous radiculomyelitis (TBRM) is an uncommon complication of TB meningitis. The authors report the case of a 10-year-old Asian girl with trisomy 21, who presented with acute urinary retention and fever. She was initially treated for a urinary tract infection. After an acute neurological deterioration she was found to have evidence of TB meningitis with TBRM. She developed acute hydrocephalus requiring ventriculo-peritoneal shunt. She was treated with quadruple antituberculous therapy and high dose intravenous dexamethasone. She needed tracheostomy with continuous positive airway pressure (CPAP) support. Although she showed gradual neurological improvement in her cognitive functions, she persisted to have quadriparesis with the need for tracheostomy and CPAP support overnight and gastrostomy feeding. Acute urinary retention in children is uncommon, and should serve as a 'red flag' to consideration of further underlying neurological problems. This presentation and subsequent events should serve as a learning point to clinicians.
authors.affiliation: Children's Hospital, Leicester Royal Infirmary, Leicester, UK. arani.sridhar@uhl-tr.nhs.uk
authors.forename: Arani
authors.initials: A
authors.lastname: Sridhar
authors.forename: Jasjit K
authors.initials: JK
authors.lastname: Bhandari
authors.forename: Gareth
authors.initials: G
authors.lastname: Lewis
authors.forename: Subramanian
authors.initials: S
authors.lastname: Ganesan
authors.forename: Srinivas
authors.initials: S
authors.lastname: Parepalli
authors.forename: Lara
authors.initials: L
authors.lastname: Abulhoul
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D003907:Dexamethasone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004314:Down Syndrome / Q000150:complications*; D004359:Drug Therapy, Combination; D005260:Female; D005774:Gastrostomy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D009187:Myelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D011843:Radiculopathy / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D014139:Tracheostomy; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D016055:Urinary Retention / Q000209:etiology*
chemical_list: D000995:Antitubercular Agents; D005938:Glucocorticoids; D003907:Dexamethasone