Nia Gilmore, BS
Medical Student
ECU Health Brody School of Medicine
Greenville, North Carolina, United States
Morgan Howells-Resendez, MD
Resident Physician
East Carolina University Health Medical Center
Greenville, North Carolina, United States
Alexandria Ochs, DO
Resident Physician
ECU Health
Greenville, North Carolina, United States
Abigail Morales, MD
Clinical Associate Professor
East Carolina University Health Medical Center
Greenville, North Carolina, United States
A 13-year-old female with no medical history was admitted after collapsing. She presented with bilateral lower extremity pain that progressed to: weakness, paresthesias, urinary retention, and loss of bowel sensation. Admission exam revealed: weakness, diminished sensation, absent deep tendon reflexes, and radicular pain with spine flexion. Evaluation raised concern for meningitis, but lumbar puncture showed low protein and a negative meningitis panel. CT and MRI Brain were unremarkable. Spinal MRI revealed immune-mediated inflammation or demyelination of the lower thoracic cord, consistent with ATM, triggered by Mycoplasma pneumoniae infection confirmed with immunofluorescence. After azithromycin and high-dose steroids, the patient experienced pain relief but continued to have sensory and bowel/bladder dysfunction. She received IVIG and was admitted to inpatient rehabilitation, where bowel and bladder dysfunction improved and strength increased.
Discussions:
ATM is a rare neurological condition characterized by inflammation of the spinal cord, leading to rapid onset of pain, muscle weakness, sensory loss, and incontinence. Approximately 1 in 1 million adults are diagnosed with ATM every year–in pediatric patients the rate is 1 in 2 million. Pediatric patients with ATM have significantly better prognosis, with 50% making full recovery in 2 years–adults have a 30% chance of making a full recovery in the same time. ATM often results secondary to infection or in the setting of autoimmune disorders. It typically affects the thoracic spinal cord. Histopathology is characterized by infiltration, demyelination, and axonal injury by monocytes and lymphocytes. Symptomatology ranges from mild weakness to permanent disability.
Conclusions:
Accurate identification of the source of neurological deficits is important to prevent delays in delivery of care. Early glucocorticoid administration and intensive therapies significantly improved prognosis. When encountering pediatric patients with symptoms of ATM, it is important to consider M. pneumoniae as a potential cause.
