We report a case of myelitis after plasma-derived hepatitis B vaccination. The patient was a 31-year-old man who presented with progressive sensory symptoms in extremities that developed 2 weeks after a third vaccination. MRI of the cervicothoracic region revealed swelling and T2 high signal at the level of C4 to C5 cord, and isolated enhancement in the posterior columns between C4 and C5 cord. The significance of MRI findings and HLA haplotype of the patient will be briefly discussed.
Acute Disease ; Adult ; Case Report ; Hepatitis B Vaccines/adverse effects* ; Human ; Magnetic Resonance Imaging ; Male ; Myelitis/pathology ; Myelitis/chemically induced*

OBJECTIVETo summarize the clinical features and therapeutic approach of systemic lupus erythematosus (SLE) complicated by transverse myelitis (TM).

METHODSThe clinical characteristics, laboratory examinations, treatment and prognosis of 6 SLE cases with TM were retrospectively analyzed with review of the literatures.

RESULTSThe 6 patients consisted of 5 females and 1 male aged 14 to 36 years (mean 23 years). The mean duration from symptom onset of SLE to TM was 8 months (1 to 13 months). All the patients had lower limb hypodynamia, and 3 of them developed upper limb hypodynamia. MRI scanning of the spine identified lesions in the cervical spinal cord in 2 cases, thoracic lesions in 3 cases, and multiple involvement of the cervical, thoracic and lumbar cord in 1 case. Examination of the cerebrospinal fluid yielded no specific findings except for leukocytosis in 1 case and hypoglycemia in another. Five cases were treated with high-dose MP+CTX, and the other case was treated with MP (80 mg/day)+CTX. Five patients responded favorably to the treatment, while the other showed no obvious improvement.

CONCLUSIONTM is a rare complication of SLE affecting mostly young patients and occurring in the early stage of the disease. Early diagnosis and aggressive treatment might improve the prognosis.

Adolescent ; Adult ; Female ; Humans ; Lupus Erythematosus, Systemic ; complications ; Magnetic Resonance Imaging ; Male ; Myelitis, Transverse ; complications ; Spinal Cord ; pathology ; Young Adult

Radiation myelitis is a rather rare, but irreversible fatal complication, Etiology, pathologic change, clinical symptoms and the method of diagnosis have been studies, pathogenesis of post-irradiation myelitis and the level of tolerance dose still remain controversial. Thoracolumbar spine of 110 hybrid mice were irradiated with orthovoltage x-ray machine. Mild capillary congestion and axonal welling were observed in 1,000rad irradiated specimens were also observed. These results suggest that 5,000 rad is not a completely safe tolerable dose which have been accepted and we cannot exclude direct radiation damage to nerve tissue as the causative pathology of radiation myelitis in addition to blood vessel damage.
Animals ; Axons ; Blood Vessels ; Capillaries ; Diagnosis ; Estrogens, Conjugated (USP) ; Mice* ; Myelitis ; Nerve Tissue ; Pathology ; Spinal Cord* ; Spine

Methylmalonyl CoA mutase deficiency due to MUT gene defect has been known as the main cause of isolated methylmalonic acidemia in Mainland China. This study reported a patient with isolated methylmalonic aciduria (MUT type) characterized as acute brainstem encephalitis and myelitis. The previously healthy girl presented with fever, lethargy and progressive weakness in her extremities at the age of 3 years and 2 months. Three day later, she had respiratory distress and consciousness. Cranial MRI revealed bilateral symmetrical lesion of pallidum, brain stem and spinal cord, indicating acute brainstem encephalitis and myelitis. Her blood propionylcarnitine (6.83 μmol/L vs normal range 1.0 to 5.0 μmol/L) and urinary methylmalonic acid (133.22 mmol/mol creatinine vs normal range 0.2 to 3.6 mmol/mol creatinine) increased significantly. Plasma total homocysteine was normal. On her MUT gene, a reported mutation (c.1630_1631GG>TA) and a novel mutation (c.1663C>T, p.A555T) were identified, which confirmed the diagnosis of methylmalonic aciduria (MUT type). After cobalamin injection, protein-restricted diet with the supplements of special formula and L-carnitine, progressive improvement has been observed. The clinical manifestation of patients with methylmalonic aciduria is complex. Metabolic study and gene analysis are keys for the diagnosis and treatment of the disorder.
Acute Disease ; Amino Acid Metabolism, Inborn Errors ; etiology ; Brain Stem ; pathology ; Child, Preschool ; Encephalitis ; etiology ; Female ; Humans ; Methylmalonyl-CoA Mutase ; genetics ; Mutation ; Myelitis ; etiology

We present an interesting case of conus medullaris cavernoma that was initially treated as transverse myelitis. Haemorrhagic lumbar puncture led us to perform magnetic resonance (MR) imaging, which showed the presence of a cavernous angioma at the D12-L1 level. The total excision of the lesion was followed by dramatic improvement. We suggest that MR imaging be performed early in all suspected cases of transverse myelitis so that emergency surgical intervention can be offered before the development of permanent neurological deficits.
Cerebrospinal Fluid ; metabolism ; Diagnosis, Differential ; Hemangioma, Cavernous ; diagnosis ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myelitis, Transverse ; diagnosis ; Neurosurgical Procedures ; Spinal Cord ; pathology

OBJECTIVEAcute Transverse myelitis (ATM) is a focal inflammatory disorder of the spinal cord, resulting in motor, sensory, and autonomic nerve dysfunction. There is often a clearly defined rostral border of sensory dysfunction. Nowadays, the pathogenesis of ATM is not clear. The present study aimed to understand possible relationship between ATM and infection with Coxsackievirus B.

METHODSIgM antibody against Coxsackievirus B was detected in cerebrospinal fluid of 33 patients with ATM.

RESULTSIn 7 of the 33 cases with ATM, the IgM andtibody Coxsackievirus B (CVB) was positive. No infections with other pathogens were found at the onset of the disease.

CONCLUSIONThe pathogenesis of ATM may involve infection with Coxsackievirus B.

Adult ; Antibodies, Viral ; cerebrospinal fluid ; immunology ; Enterovirus B, Human ; immunology ; pathogenicity ; physiology ; Female ; Humans ; Immunoglobulin M ; cerebrospinal fluid ; immunology ; Male ; Middle Aged ; Myelitis, Transverse ; cerebrospinal fluid ; immunology ; pathology ; virology ; Retrospective Studies

Atopic myelitis is defined as myelitis with atopic diasthesis but the cause is still unknown. Toxocariasis is one of the common causes of hyperIgEaemia that may lead to neurologic manifestations. The purpose of this study was to evaluate the sero-prevalence of Toxocara specific IgG Ab among the atopic myelitis patients. We evaluated the medical records of 37 patients with atopic myelitis whose conditions were diagnosed between March 2001 and August 2007. Among them, the 33 sera were analyzed for specific serum IgG Ab to Toxocara excretory-secretory antigens (TES). All of 37 patients had hyperIgEaemia. Specific IgE to D. pteronyssinus and D. farinae was detected in 22 (64.7%) and 34 (100%) patients, respectively, of the 34 patients. Thirty-one of 33 patients (93.9%) were found to be positive by TES IgG enzyme-linked immunosorbent assay (ELISA). Based on the image findings of eosinophilic infiltrations in the lung and liver, 8 patients had positive results. These results inferred that the prevalence of toxocariasis was high in patients with atopic myelitis. Our results suggest that toxocariasis might be an important cause of atopic myelitis and Toxocara ELISA is essential for evaluating the causes of atopic myelitis.
Adult ; Albendazole/therapeutic use ; Animals ; Anthelmintics/therapeutic use ; Antibodies, Helminth/blood/immunology ; Humans ; Immunoglobulin E/blood/immunology ; Magnetic Resonance Imaging ; Middle Aged ; Myelitis/drug therapy/*etiology/*immunology/pathology ; Retrospective Studies ; Toxocara/*immunology ; Toxocariasis/*complications/drug therapy/*immunology/pathology ; Treatment Outcome ; Young Adult