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