200 Section - A Rare Case of Myeloradiculitis with Positive Antinuclear Antibody and Toxocariasis

Case Diagnosis: Myeloradiculitis with Positive Antinuclear Antibody and Toxocariasis

Case Description: A 69-year-old woman presented with dizziness, hypoesthesia in both posterior lower legs, progressive motor weakness in the lower limbs, urinary retention, and constipation. Spine MRI revealed focal linear enhancement at the T12–L1 spinal cord, suggestive of acute transverse myelitis, for which she received methylprednisolone. Follow-up MRI showed segmental swelling with enhancement of the central spinal cord and conus medullaris (T11–L1). Deep tendon reflexes were decreased bilaterally. Initial CSF analysis showed 1/mm³ RBCs, 1/mm³ WBCs, protein 56.7 mg/dL, and glucose 70 mg/dL. She completed a 5-day course of IV immunoglobulin. Positive antinuclear antibody (1:40) and toxocariasis led to albendazole treatment. Somatosensory evoked potentials showed no response to bilateral posterior tibial nerve stimulation. Electromyography indicated multiple lumbosacral radiculopathies with myelopathy. After physical therapy, her neurological status showed partial improvement.

Discussions: Myelitis affects the spinal cord and can lead to motor weakness, sensory deficits, and autonomic dysfunction, depending on the level involved. Identifying the underlying cause can be challenging. In this case report, we describe a rare instance of myeloradiculitis associated with toxocariasis, highlighting the importance of recognizing and managing co-existing neurological conditions.

Conclusions:

We report a rare case of myeloradiculitis accompanied by a positive antinuclear antibody and toxocariasis. Clinicians should recognize that patients with confirmed spinal cord lesions may also have co-existing neurological abnormalities. Performing NCS/EMG is recommended to rule out overlapping peripheral neurological disorders.