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Tuberculosis myelitis usually impact adult patients and associated with tuberculous meningitis, miliary tuberculosis, or human immunodeficiency virus infection. Pediatric tuberculosis myelitis cases without any associated diseases have never been reported. The author reported a case of a pediatric patient with tuberculosis myelitis without any other organ involvement and the outcome after treatment. Girl 13 years old suffered from paraplegia of her lower extremities. Two months before paraplegia she felt weakness in her left leg and followed by the right side. The legs were spastic and ankle clonus was positive. She lost sensation from epigastrium level to her both of legs and difficult to bowel. Laboratories result was normal but spinal magnetic resonance imaging showed hyperintense lesion of spinal cord thoracic vertebrae 5-8. During the laminectomy procedure, there was no any tumor, abscess, or tuberculoma, but the spinal cord looked brown. A biopsy was performed, and the histopathology results showed the granuloma containing lymphocytes, epithelioid macrophages, and datia langhans cells. The patient was treated with anti-tuberculosis chemotherapy for twelve months. Clinical symptoms improved gradually and the patient was able to walk slowly. Tuberculosis myelitis is an inflammatory spinal cord disease and it can cause paralyzed, sensory and autonomic disturbance. Magnetic resonance imaging can differentiate between spinal tuberculosis and spinal tumors, but it will be difficult if there are no signs of vertebral body and discs inflammation. Tuberculosis myelitis should be considered as a differential diagnosis of spinal cord lesions in children and its response to anti-tuberculosis chemotherapy is excellent.
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- Global tuberculosis report 2020, Geneva: World Health Organization; 2020. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports.
- Indonesia Health Ministry: Laporan nasional riset kesehatan dasar 2018. Available from: http://labdata.litbang.kemkes.go.id/images/download/laporan/RKD/2018/Laporan_Nasional_RKD2018_FINAL.pdf.
- Pigrau-Serrallach C, Rodriguez-Pardo D. Bone and joint tuberculosis. Eur Spine J. 2013;22(suppl 4):556-66. DOI:10.1007/s00586-012-2331-y
- Garg RK, Somvanshi DS. Spinal tuberculosis: A review. J Spinal Cord Med. 2011;34(5):440-54. DOI: 10.1179/2045772311Y.0000000023
- Moon MS, Kim SS, Lee BJ, et al. Spinal tuberculosis in children: Retrospective analysis of 124 patients. Indian J Orthop. 2012;46(2):150-8. DOI:10.4103/0019-5413.93676
- Shashikumar MR, Basavaraj SB, Vishwanath VJ, et al. Role of MRI in the evaluation of spinal tuberculosis. Int J Res Med Sci. 2015;3(8):1839-43. DOI: 10.18203/2320-612.ijrms.20150282
- Gupta R, Garg RK, Jain A, et al. Spinal cord and spinal nerve root involvement (myeloradiculopathy) in tuberculous meningitis. Medicine (Baltimore). 2015;94(3):e404. DOI: 10.1097/MD.0000000000000404
- Borra SL, Kodali VU, Sanda MR, et al. Inramedullary tuberculomas of cervical spinal cord in a young immunocompetent patient: A case report. J Clin Diag Res. 2011;5(5):1111-13.
- Turamari RU, Nagarajaiah PKC, Nanjaraj CP, et al. MRI evaluation of tuberculosis spine. Int J Cont Med Surg Rad. 2018;3(3):C44-7. DOI: 10.21276/ijcmsr.2018.3.3.10
- Garg D, Goyal V. Spinal tuberculosis treatment: An enduring bone of contention. Ann Indian Acad Neurol. 2020;233:441-8. DOI:10.4103/aian.AIAN_141_20
- Garg RK, Malhotra HS, Gupta R. Spinal cord involvement in tuberculosis meningitis. Spinal Cord. 2015;53:649-57. DOI:10.1038/sc.2015.58
- Shah KK, Pritt BS, Alexander MP. Histopathologic review of granulomatous inflammation. J Clin Tuberc Other Mycobac Dis. 2017;7:1-12. DOI: 10.1016/j.jctube.2017.02.001
- Pu F, Feng J, Yang L, et al. Misdiagnosed and mismanaged atypical spinal tuberculosis: A case series report. Exp Ther Med. 2019;18(5):3723-8. DOI: 10.3892/etm.2019.8014
- Rajasekaran S, Soundarajan DCR, Shetty Ap, et al. Spinal tuberculosis: Current concepts. Global Spine J. 2018;8(4suppl):96S-108S. DOI: 10.1177/2192568218769503
- Marais S, Roos I, Mitha A, et al. Spinal tuberculosis: Clinicoradiological findings in 274 patients. Clin Infect Dis. 2018;67(1):89-98. DOI: 10.1093/cid/ciy020
- Rosales OA, Torres ND, Rosales CB. A rare neurological complication of tuberculosis: Transverse myelitis. IDCases. 2019;17:e00564. DOI: 10.1016/j.idcr.2019.e00564
- Wasay M, Arif H, Khealani B, et al. Neuroimaging of tuberculosis myelitis: Analysis of ten cases and review of literature. J Neuroimaging. 2006;16(3):197-205. DOI: 10.1111/j.1552-6569.2006.00032.x
- Sahu SK, Giri S, Gupta N. Longitudinal extensive transverse myelitis due to tuberculosis: A report of four cases. J Postgrad Med. 2014;60:409-12. DOI: 10.4103//0022-3859.143977
- Noh MSFM, Bahari N, Rashid AMA. Tuberculous myelopathy associated with longitudinally extensive lesion: A clinicoradiological review of reported cases. J Clin Neurol. 2020;16(3):369-75. DOI: 10.3988/jcn.2020.16.3.369