Disclosures: Andrew J. Duarte, MD: Nothing to disclose

Case Description: A 57-year-old female ultimately diagnosed with transverse myelitis who presented with a distal ascending polyneuropathy that was initially concerning for acute inflammatory demyelinating polyneuropathy.

Setting: Tertiary academic medical center.

Patient: The patient is a 57-year-old right hand dominant female with several medical comorbidities including diabetes and hypothyroidism who presented with acute onset of rapidly progressive bilateral lower extremity paresthesias and weakness. Additionally, she verbalized bladder dysfunction. Initial physical exam revealed bilateral lower extremity weakness which was noted to be more severe distally. Lumbar puncture was negative for oligoclonal bands and without evidence of albuminocytologic dissociation. MRI of the patient’s spine revealed two foci of hyperintensity: a single 1.9 cm hyperintensity at C1-C2 and a second discrete lesion at T3 consistent with longitudinally extensive transverse myelitis (LETM).

Assessment/Results: n/a

Discussion: Among the inflammatory neuropathies, transverse myelitis (TM) is a rare diagnosis that is less well-defined. There are several different degrees of transverse myelitis depending on how extensive the degree of myelopathy is seen on imaging and the patient’s symptomatology. Acute inflammatory demyelinating polyneuropathy (AIDP) is a diagnosis that is more common, often involves upper and lower extremities concordantly, and has no findings noted on spinal MRI. Another subtle distinguishing feature of TM is that autonomic involvement affects the genitourinary system primarily, as was seen with this patient, while in AIDP the cardiovascular system is more often affected. This case demonstrates the nuanced differences of TM and AIDP very well and is worth highlighting. It is important to make this distinction as management of the two pathologies is very different.

Conclusion: While a patient may present with symptoms initially concerning for AIDP, a broad differential diagnosis should be maintained so as not to exclude the diagnosis of TM.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-atypical-presentation-of-transverse-myelitis-a-case-report/