J Korean Rheum Assoc.  2005 Jun;12(2):154-158.

A Case of Tuberculous Myelitis Misdiagnosed as Lupus Myelitis

• Shin HJ
• Jeon SJ
• Kim DK
• Ahn KS
• Kim HJ
• Lee CW

Abstract

In systemic lupus erythematosus (SLE), besides immunosuppressive therapy, the immunological abnormalities such as impaired phagocytosis and deficiency of cell-mediated immunity contribute to the increased risk of infection. Most of all, the incidence of tuberculous infection is higher and the pattern tends to be more extensive and extrapulmonary than in general population. Therefore the contributory role of tuberculous infection in mortality of SLE should be emphasized, especially in areas endemic for Mycobacterium tuberculosis like Korea. When tuberculous infection involves central nervous system, it can mimic lupus myelitis, showing the clinical manifestations like paraplegia, sensory impairment and bladder dysfunction. Tuberculous myelitis should be differentiated with lupus myelitis as early as possible for proper treatment and better prognosis. We report a 52 year-old woman with SLE presented with paraplegia and urinary incontinence, who were initially suspected as lupus myelitis. But the AFB smear and culture of cerebrospinal fluid were compatible with tuberculosis myelitis.

Keyword

Tuberculous myelitis; Lupus myelitis; Systemic lupus erythematosus

MeSH Terms

Central Nervous System
Cerebrospinal Fluid
Female
Humans
Immunity, Cellular
Incidence
Korea
Lupus Erythematosus, Systemic
Middle Aged
Mortality
Mycobacterium tuberculosis
Myelitis*
Paraplegia
Phagocytosis
Prognosis
Tuberculosis
Urinary Bladder
Urinary Incontinence