Recurrent transverse myelitis following neurobrucellosis: immunologic features and beneficial response to immunosuppression

J Neurovirol. 2005 Apr;11(2):225-31. doi: 10.1080/13550280590922801.

Abstract

The authors report the clinical course and immune system response of a patient with disease-associated recurrent transverse myelitis (TM) following cerebral infection with Brucellosis melitensis. The patient suffered four recurrences of his TM (each at a distinct spinal cord level) over the course of 2 years following his initial presentation, which ultimately progressed to quadriplegia. He had progressively declining cerebrospinal fluid (CSF) brucella antibody titers, suggesting a postinfectious, rather than an infectious, etiology. The authors simultaneously examined the expression of multiple cytokines in the CSF of this patient using cytokine antibody arrays and found a marked elevation of interleukin (IL)-6, IL-8, and macrophage chemoattractant protein (MCP)-1 levels relative to controls. Quantitative enzyme-linked immunosorbent assay (ELISA) analysis of the CSF confirmed a 1700-fold elevation of IL-6 and more modest elevations of IL-8 and MCP-1. IL-6 levels returned to baseline following treatment of the patient with intravenous cyclophosphamide and plasma exchange and the patient experienced a significant and sustained recovery of function.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Brucellosis / complications*
  • Chemokine CCL2 / cerebrospinal fluid
  • Cyclophosphamide / administration & dosage
  • Cyclophosphamide / therapeutic use*
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Injections, Intravenous
  • Interleukin-6 / cerebrospinal fluid
  • Interleukin-8 / cerebrospinal fluid
  • Male
  • Myelitis, Transverse* / drug therapy
  • Myelitis, Transverse* / etiology
  • Myelitis, Transverse* / immunology
  • Recurrence
  • Spinal Cord / pathology
  • Treatment Outcome

Substances

  • Chemokine CCL2
  • Immunosuppressive Agents
  • Interleukin-6
  • Interleukin-8
  • Cyclophosphamide