Case Description
A 47 year old man, farmer from eastern Sudan presented with lower limbs weakness which was gradually progressive over 20 days ,the patient became completely unable to walk 8 days prior to admission. The weakness associated with lower back pain, numbness of lower limbs as well as urine retention and constipation. No headache , convulsions or loss of consciousness, no symptoms related to cranial nerve nor the upper limbs ,no neck pain and no history of trauma. There was history of fever, night sweating loss of appetite . No loss of weight chronic cough.The condition is not preceded by URTI nor gastroenteritis. Not known to be diabetic , hypertensive or any chronic illness. Family history:Nothing was significant Drug history: Not on LTM. Not known allergic to certain drug. Social history:Married with 2 kids, neither smoker nor alcohol consumer. Looked unwell, average size not pale , jaundiced or cyanosed PR: 70/min. regular ,RR: 20/min , BP::160/90 .Chest / CVS / abdomen : were normal Neurology examination: Conscious ,fully oriented with intact memory and speech a Cranial nerves were intact including the fundus .Normal neck examination. Normal upper limbs examination. Lower limbs examination revealed hypertonia hyperreflexia power was grade 2 with impaired sensation up to D7.Planter were up going. Back examination revealed lower back tenderness , no deformities.CBC:HB 12.9g/dl TWBCs 7.8c/cm PLT 262c/cm . Blood urea 41g/dl S.Cr 1.0mg/dl S.k 4.3mmol/l
RBG:100 gg/dl BFFM –ve LFT: normal HIV –ve HBV screening –ve HCV screening –ve ESR : 70 mm/hour PSA :2.4 PCR +ve for Tuberculosis in the CSF. Chest x-ray: Normal. Initial MRI Doral spine were shown below which was reported as :Discitis at the level D8 and D9