SANUM: Revista Científico-Sanitaria / Scientific-Health Journal
Published October 30, 2026 | Version v1
Journal article Open

MIELORRADICULOPATÍA TUBERCULOSA SECUNDARIA A MENINGITIS TUBERCULOSA: REPORTE DE CASO CON REVISIÓN NARRATIVA DE LA LITERATURA

Authors/Creators

  • 1. Facultad de Medicina, Universidad Libre. Cali, Colombia
  • 2. Facultad de Salud, Universidad del Valle. Cali, Colombia
  • 3. Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia.
  • 4. Universidad Cooperativa de Colombia. Santa Marta, Colombia
  • 5. ROR icon Universidad Libre de Colombia

Description

Tipo de artículo: Caso clínico

La meningitis tuberculosa (MBT) es la forma más grave de tuberculosis extrapulmonar y puede complicarse con mielorradiculopatía secundaria a aracnoiditis tuberculosa, una entidad neurológica infrecuente pero altamente discapacitante, presente hasta en el 46,4% de los pacientes en series prospectivas. El presente reporte describe el caso de un hombre de 29 años con contacto domiciliario con tuberculosis activa, diagnosticado con MBT por reacción en cadena de la polimerasa (PCR) positiva en líquido cefalorraquídeo (LCR), quien desarrolló hepatotoxicidad al esquema antituberculoso inicial y deterioro neurológico progresivo con paraparesia, arreflexia y compromiso de la cola de caballo.

La resonancia magnética (RM) evidenció paquimeningitis tuberculosa, mielopatía torácica a nivel T9-T10 y polirradiculopatía inflamatoria. Se instauró esquema alternativo con isoniazida, etambutol, moxifloxacina y linezolid con piridoxina empírica, corticosteroides y rehabilitación integral, logrando mejoría neurológica parcial con compromiso severo de la dependencia para las actividades básicas de la vida diaria.

Se realiza una revisión narrativa de la literatura que sintetiza la fisiopatología, el diagnóstico diferencial, las opciones terapéuticas ante hepatotoxicidad y el pronóstico de esta entidad, subrayando la importancia de la RM con gadolinio como herramienta diagnóstica fundamental y de la rehabilitación neurológica precoz como determinante del pronóstico funcional.

Abstract (English)

Article type: Clinical case

Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis and may be complicated by myeloradiculopathy secondary to tuberculous arachnoiditis, an infrequent but highly disabling neurological entity present in up to 46.4% of patients in prospective series. This report describes a 29-year-old man with household contact with active tuberculosis, diagnosed with TBM by positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR), who developed antituberculosis drug-induced hepatotoxicity and progressive neurological deterioration with paraparesis, areflexia, and cauda equina involvement.

Magnetic resonance imaging (MRI) revealed tuberculous pachymeningitis, thoracic myelopathy at T9-T10, and inflammatory polyradiculopathy. An alternative regimen with isoniazid, ethambutol, moxifloxacin, linezolid, empiric pyridoxine, corticosteroids, and comprehensive rehabilitation was initiated, achieving partial neurological recovery with severe compromise of dependence for basic activities of daily living.

A narrative review of the literature is presented synthesizing pathophysiology, differential diagnosis, therapeutic options for hepatotoxicity, and prognosis, emphasizing the importance of gadolinium-enhanced MRI as the fundamental diagnostic tool and early neurological rehabilitation as critical for functional outcome.

Files

sanum_v10_n4_a21.pdf

Files (676.5 kB)

Name Size
md5:4b2cadc234dafb503cbdc69b5bde9ea3
676.5 kB Preview Download

Additional details

Additional titles

Translated title (English)
TUBERCULOUS MYELORADICULOPATHY SECONDARY TO TUBERCULOUS MENINGITIS: CASE REPORT WITH NARRATIVE REVIEW OF THE LITERATURE

Dates

Collected
2026-07-13
manuscrito recibido
Accepted
2026-08-23
evaluación doble ciego
Available
2026-10-30
publicación en numero de la revista

Software

Repository URL
https://revistacientificasanum.com/
Development Status
Active

References

  • 1. WHO. Global tuberculosis report 2025 [Internet]. Ginebra: World Health Organization; 2025. ISBN: 978-92-4-011692-4. Disponible en: www.who.int/publications/i/item/9789240116924 2. Leonard JM. Central Nervous System Tuberculosis. Microbiol Spectr. 2017;5(2). doi:10.1128/microbiolspec.TNMI7-0044-2017 3. Wilkinson RJ, Rohlwink U, Misra UK, van Crevel R, Mai NTH, Dooley KE, et al. Tuberculous meningitis. Nat Rev Neurol. 2017;13(10):581-598. doi:10.1038/nrneurol.2017.120 4. Stadelman AM, Ellis J, Samuels THA, Mutengesa E, Dobbin J, Ssebambulidde K, et al. Treatment outcomes in adult tuberculous meningitis: a systematic review and meta-analysis. Open Forum Infect Dis. 2020;7(8):ofaa257. doi:10.1093/ofid/ofaa257 5. Gupta R, Garg RK, Jain A, Malhotra HS, Verma R, Sharma PK. Spinal cord and spinal nerve root involvement (myeloradiculopathy) in tuberculous meningitis. Medicine. 2015;94(3):e404. doi:10.1097/MD.0000000000000404 6. Saukkonen JJ, Cohn DL, Jasmer RM, Schenker S, Jereb JA, Nolan CM, et al. An official ATS statement: hepatotoxicity of antituberculosis therapy. Am J Respir Crit Care Med. 2006;174(8):935-52. doi:10.1164/rccm.200510-1666ST 7. Carabalí-Isajar ML, Rodríguez-Bejarano OH, Amado T, Patarroyo MA, Izquierdo MA, Lutz JR, et al. Clinical manifestations and immune response to tuberculosis. World J Microbiol Biotechnol. 2023;39(8):206. doi:10.1007/s11274-023-03636-x 8. Daniel DM, Hansdak SG, George T, Thomas SM, Balachandran A, Vanjare HA, et al. Clinical profile, outcomes, and predictors of outcomes in patients with tuberculosis with arachnoiditis. Int J Mycobacteriol. 2025;14(2):126-131. doi:10.4103/ijmy.ijmy_29_25 9. Lyon SM, Rossman MD. Pulmonary Tuberculosis. Microbiol Spectr. 2017;5(1). doi:10.1128/microbiolspec.TNMI7-0032-2016 10. Seddon JA, Tugume L, Solomons R, Prasad K, Bahr NC. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome Open Res. 2019;4:167. doi:10.12688/wellcomeopenres.15535.1 11. Leowattana W, Leowattana P, Leowattana T. Tuberculosis of the spine. World J Orthop. 2023;14(5):275-93. doi:10.5312/wjo.v14.i5.275 12. Yang S, Yu Y, Ji Y, Luo DJ, Zhang ZY, Huang GP, et al. Multi-drug resistant spinal tuberculosis—epidemiological characteristics of in-patients: a multicentre retrospective study. Epidemiol Infect. 2020;148:e11. doi:10.1017/S0950268820000011 13. Wang H, Li C, Wang J, Zhang Z, Zhou Y. Characteristics of patients with spinal tuberculosis: seven-year experience of a teaching hospital in Southwest China. Int Orthop. 2012;36(7):1429-34. doi:10.1007/s00264-012-1511-z 14. Wang P, Liao W, Cao G, Jiang Y, Rao J, Yang Y. Characteristics and management of spinal tuberculosis in tuberculosis endemic area of Guizhou Province: a retrospective study of 597 patients in a teaching hospital. BioMed Res Int. 2020;2020:1468457. doi:10.1155/2020/1468457 15. Marais S, Roos I, Mitha A, Mabusha SJ, Patel V, Bhigjee AI. Spinal tuberculosis: clinicoradiological findings in 274 patients. Clin Infect Dis. 2018;67(1):89-98. doi:10.1093/cid/ciy020 16. Moghtaderi A, Alavi Naini R. Tuberculous radiculomyelitis: review and presentation of five patients. Int J Tuberc Lung Dis. 2003;7(12):1186-90. 17. Garg RK. Tuberculosis of the central nervous system: current concepts in diagnosis and treatment. Curr Opin Neurol. 2025;38(4):406-413. doi:10.1097/WCO.0000000000001358 18. Jiang Y, Xu X, Guo Z, Liu Y, Lin J, Suo L, et al. Myelitis: a common complication of tuberculous meningitis predicting poor outcome. Front Neurol. 2022;13:830029. doi:10.3389/fneur.2022.830029 19. Khan MI, Garg RK, Rizvi I, Malhotra HS, Kumar N, Jain A, et al. Tuberculous myelitis: a prospective follow-up study. Neurol Sci. 2022;43(9):5615-24. doi:10.1007/s10072-022-06221-6 20. Liao PW, Chiang TR, Lee MC, Huang CH. Tuberculosis with meningitis, myeloradiculitis, arachnoiditis and hydrocephalus: a case report. Acta Neurol Taiwan. 2010;19(3):189-93. 21. Moule MG, Cirillo JD. Mycobacterium tuberculosis dissemination plays a critical role in pathogenesis. Front Cell Infect Microbiol. 2020;10:65. doi:10.3389/fcimb.2020.00065 22. Garg RK, Malhotra HS, Gupta R. Spinal cord involvement in tuberculous meningitis. Spinal Cord. 2015;53(9):649-57. doi:10.1038/sc.2015.58 23. Dahal P, Parajuli S. Magnetic resonance imaging findings in central nervous system tuberculosis: a pictorial review. Heliyon. 2024;10(8):e29779. doi:10.1016/j.heliyon.2024.e29779 24. Garg D, Radhakrishnan DM, Agrawal U, Vanjare HA, Gandham EJ, Manesh A. Tuberculosis of the spinal cord. Ann Indian Acad Neurol. 2023;26(2):112-126. doi:10.4103/aian.aian_578_22 25. Kannapadi NV, Alomari SO, Caturegli G, Bydon A, Cho SM. Management of syringomyelia associated with tuberculous meningitis: a case report and systematic review of the literature. J Clin Neurosci. 2021;87:20-25. doi:10.1016/j.jocn.2021.01.052 26. Davis A, Meintjes G, Wilkinson RJ. Treatment of tuberculous meningitis and its complications in adults. Curr Treat Options Neurol. 2018;20(3):5. doi:10.1007/s11940-018-0490-9 27. Prus D, Lenox R. Moxifloxacin-induced peripheral neuropathy: a rare side effect of fluoroquinolone therapy in tuberculosis management. Cureus. 2026;18(2):e103314. doi:10.7759/cureus.103314 28. van der Watt JJ, Harrison TB, Benatar M, Heckmann JM. Polyneuropathy, anti-tuberculosis treatment and the role of pyridoxine in the HIV/AIDS era: a systematic review. Int J Tuberc Lung Dis. 2011;15(6):722-8. doi:10.5588/ijtld.10.0284