Pulse corticosteroids for the management of extensive CNS tuberculosis presenting with acute-onset quadriparesis

Drug Discov Ther. 2022 May 17;16(2):102-104. doi: 10.5582/ddt.2021.01015. Epub 2022 Mar 24.

Abstract

Myelopathy in central nervous system tuberculosis is notorious for poor outcomes, determined by the severity of inflammation and cord level involved. Acute-onset quadriplegia or paraplegia in these cases represents a neuro-emergency. We report a young female with disseminated tuberculosis who presented with acute onset flaccid quadriparesis with loss of bladder and bowel function. Imaging helped identify the extensive involvement of the neuraxis. We propose that, in addition to anti-tubercular therapy, high-dose corticosteroids such as pulse methylprednisolone may result in a meaningful improvement and show greater rapidity of response in cases of severe central nervous system inflammation such as arachnoiditis or myelopathy.

Keywords: Tuberculosis; immunosuppression; meningitis; myelopathy.

MeSH terms

  • Adrenal Cortex Hormones
  • Female
  • Humans
  • Inflammation
  • Quadriplegia / drug therapy
  • Quadriplegia / etiology
  • Spinal Cord Diseases*
  • Tuberculosis, Central Nervous System* / complications
  • Tuberculosis, Central Nervous System* / diagnostic imaging
  • Tuberculosis, Central Nervous System* / drug therapy

Substances

  • Adrenal Cortex Hormones