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Intramedullary tuberculosis manifested as Brown - Sequard syndrome in a patient with systemic lupuserythematosus

Center for Rheumatic Diseases, Research Center in CatholicMedical Center, Kang-Nam St. Mary's Hospital, Department of Internal Medicine Sang-Heon Lee Center for Rheumatic Diseases, ResearchCenter in CatholicMedical Center, Kang-Nam St. Mary's Hospital, Department of Internal Medicine

Byoung-Yong Shim

Center for Rheumatic Diseases, Research Center in CatholicMedical Center, Kang-Nam St. Mary's Hospital, Department of Internal Medicine

Jun-Ki Min

Center for Rheumatic Diseases, Research Center in CatholicMedical Center, Kang-Nam St. Mary's Hospital, Department of Internal Medicine

Yeon-Sik Hong

Center for Rheumatic Diseases, Research Center in CatholicMedical Center, Kang-Nam St. Mary's Hospital, Department of Internal Medicine

Sung-Hwan Park

Center for Rheumatic Diseases, Research Center in CatholicMedical Center, Kang-Nam St. Mary's Hospital, Department of Internal Medicine

Chul-Soo Cho

Center for Rheumatic Diseases, Research Center in CatholicMedical Center,Kang-Nam St. Mary's Hospital, Department of Internal Medicine

Chun-Kun Park

Department of Neurosurgery, the Catholic University of Korea, Seoul, Korea

Ho-Youn Kim

Center for Rheumatic Diseases, Research Center in CatholicMedical Center, Kang-Nam St. Mary's Hospital, Department of Internal Medicine

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 abcess. 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.

Key Words: systemic lupus erythematosus • intramedullary tuberculosis • Brown - Sequard syndrome

Lupus, Vol. 9, No. 2, 147-150 (2000)
DOI: 10.1191/096120300678828064


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