Immune-Mediated Transverse Myelitis in a Filipino Patient With Prior Hematopoietic Stem Cell Transplantation: A Case Report

TL;DR

A Filipino man with a history of cancer and stem cell transplant developed immune-mediated spinal cord inflammation, which improved with steroid treatment.

Contribution

Highlights immune-mediated transverse myelitis in a complex immunocompromised patient and successful corticosteroid treatment.

Findings

MRI showed spinal cord abnormalities consistent with transverse myelitis.

High-dose corticosteroids led to significant neurological improvement and full motor recovery.

No recurrence of myelitis was observed during follow-up.

Abstract

Transverse myelitis is an inflammatory disorder of the spinal cord that can result in significant neurologic morbidity. Diagnostic evaluation is particularly challenging in immunocompromised patients because of a broad differential diagnosis that includes infectious, neoplastic, vascular, and treatment-related etiologies. We report the case of a 64-year-old Filipino male with a history of parotid carcinoma treated with surgery and radiotherapy, acute myeloid leukemia treated with hematopoietic stem cell transplantation, and chronic immunosuppression who presented with acute-onset progressive bilateral lower extremity weakness and sensory loss. Magnetic resonance imaging of the thoracic spine demonstrated focal intramedullary signal abnormalities at the first and second thoracic spinal cord levels. Extensive infectious, neoplastic, and inflammatory investigations were unrevealing. The patient was treated for a case of immune-mediated transverse myelitis with high-dose intravenous corticosteroids, resulting in substantial neurologic improvement. He achieved full motor recovery with residual sensory deficits following rehabilitation. There was no recurrence of myelopathic symptoms during follow-up. The patient later died from pneumonia in the setting of relapse of acute myeloid leukemia, without evidence of recurrent transverse myelitis. This case underscores the importance of systematic diagnostic evaluation and early initiation of immunosuppressive therapy in suspected immune-mediated transverse myelitis, even in patients with complex oncologic and immunologic histories.

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