Tuberculous radiculomyelitis presenting as urinary retention in a child with Down’s syndrome

Tuberculous radiculomyelitis (TBRM) is an uncommon complication of TB meningitis. The authors report the case of a 10-year-old Asian girl with trisomy 21, who presented with acute urinary retention and fever. She was initially treated for a urinary tract infection. After an acute neurological deteri...

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Bibliographic Details
Published in:BMJ case reports 2012-04, Vol.2012 (apr02 1), p.bcr1020115005-bcr1020115005
Main Authors: Sridhar, Arani, Bhandari, Jasjit K, Lewis, Gareth, Ganesan, Subramanian, Parepalli, Srinivas, Abulhoul, Lara
Format: Article
Language:English
Subjects:
Antibiotics
Antitubercular Agents - therapeutic use
Blood
Child
Constipation
Dexamethasone - therapeutic use
Diagnosis, Differential
Down syndrome
Down Syndrome - complications
Drug Therapy, Combination
Encephalomyelitis
Europe (West)
Female
Gastric lavage
Gastrostomy
Glucocorticoids - therapeutic use
Humans
Hydrocephalus
Immunoglobulins
Indian Subcontinent
Lymphocytes
Magnetic Resonance Imaging
Meningitis
Myelitis - diagnosis
Myelitis - drug therapy
Myelitis - microbiology
Ostomy
Proteins
Radiculopathy - diagnosis
Radiculopathy - drug therapy
Radiculopathy - microbiology
Tracheostomy
Tuberculosis
Tuberculosis, Meningeal - complications
Tuberculosis, Meningeal - diagnosis
Tuberculosis, Meningeal - drug therapy
Unusual Presentation of More Common Disease/Injury
Urinary retention
Urinary Retention - etiology
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Summary:Tuberculous radiculomyelitis (TBRM) is an uncommon complication of TB meningitis. The authors report the case of a 10-year-old Asian girl with trisomy 21, who presented with acute urinary retention and fever. She was initially treated for a urinary tract infection. After an acute neurological deterioration she was found to have evidence of TB meningitis with TBRM. She developed acute hydrocephalus requiring ventriculo-peritoneal shunt. She was treated with quadruple antituberculous therapy and high dose intravenous dexamethasone. She needed tracheostomy with continuous positive airway pressure (CPAP) support. Although she showed gradual neurological improvement in her cognitive functions, she persisted to have quadriparesis with the need for tracheostomy and CPAP support overnight and gastrostomy feeding. Acute urinary retention in children is uncommon, and should serve as a ‘red flag’ to consideration of further underlying neurological problems. This presentation and subsequent events should serve as a learning point to clinicians.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr.10.2011.5005