A 20-year-old female presented to the emergency department with weak- ness of the lower limbs and activity disorder. After 10 days, the condition was aggravated with paralysis of the lower limbs, urinary and fecal incon- tinence, low-grade fever and night sweats, weight loss, and no cough and expectoration.
Physical examination: significantly decreased bilateral nipple medical shallow feel, abated bilateral abdominal reflex,double lower limbs muscle level 0 and 1, increased muscle tone, bilateral knee and ankle reflex disap- peared,positive bilateral pap, positive ankle clonus, and negative meningeal stimulation.
Auxiliary examination: chest CT with dual lung infiltrative pulmonary tuberculosis with tuberculosis pleuritis. MRI showed that the thoracic spinal cord was markedly swollen The T2WI shows patchy long T2 signal without enhancement. The thoracic segment and lumbar spinal membrane had clear thickening and enhancement with multiple small abscess formation.
CSF biochemical and routine examination was normal without acid fast bacilli. The erythrocyte sedimentation rate (ESR) was 34 mm/h. Fiber bron- choscope sputum smear demonstrated acid bacillus, while bronchial mucosa biopsy showed tuberculosis granuloma formation. At the same time, three CSF examinations were performed repeatedly, and the acid-proof bacillus was found in the last CSF examination of cerebrospinal fluid images. The patient was diagnosed with miliary tuberculosis and tuberculosis meningomyelitis of the thoracolumbar spinal cord. The patient was given the following anti- tuberculosis treatment: Rifampicin 0.45 g/d + ethambutol 0.75 g/d + pyrazi- namide 1.5 g/d + isoniazid 0.6 g/d. After re-examination after two months, the lesion of the spinal cord was significantly reduced, and the small abscess of the spinal membrane was significantly reduced. The strength of lower limbs was restored to 3 +, and the patient was able to walk approximately 1 km with her family's help.