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JAMA Neurology Clinical Challenge
June 2017

Multiple Spinal Lesions in an Immunocompetent Young Man

Author Affiliations
  • 1Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
  • 2Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, China
JAMA Neurol. 2017;74(6):741-742. doi:10.1001/jamaneurol.2017.0114

A 30-year-old man was referred with progressive quadriplegia for 2 months. The muscle weakness started from the right lower limb and gradually spread to the upper limb and contralateral side. Urinary retention developed 1 month later. Because he was suspected of having tubercular meningomyelitis, he received an antituberculosis regimen plus dexamethasone (10 mg daily) for 10 days. The symptoms ameliorated in the first week but thereafter deteriorated with fever. He had no history of central nervous system injury or drug overuse. He was a construction supervisor and had daily contact with moist earth. No relevant family history was reported.

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