A Case of Tuberculous Myelitis Misdiagnosed as Lupus Myelitis / 대한류마티스학회지

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.