A Case Report on Longitudinally Extensive Transverse Myelitis Associated with Salmonella typhi Exposure and Systemic Inflammation

Case Report

Abstract

Longitudinally extensive transverse myelitis is a devastating spinal cord inflammation characterized by confluent intramedullary T2/STIR hyperintensity spanning three or more contiguous vertebral bodies. Autoimmune demyelinating syndromes, parainfectious immunological cascades, and neurotropic systemic pathogens constitute the primary differential diagnoses. A 31-year-old female presented with subacute ascending sensorimotor deficits, radiating cervicothoracic pain, lower thoracic tight band dysesthesia, severe constipation, and urinary retention persisting over twenty days. Contrast-enhanced magnetic resonance neuroimaging established extensive intramedullary expansile hyperintensity extending from C2 through T3 vertebral levels, occupying over two-thirds of the spinal cord cross-sectional area. Ancillary investigations revealed systemic inflammatory markers, serological reactivity to Salmonella enterica serovar Typhi, and severe serum folate depletion, while cerebrospinal fluid analysis excluded acute bacterial meningitis and active oligoclonal banding. Ophthalmological optical coherence tomography and serological assays verified negativity for aquaporin-4 and myelin oligodendrocyte glycoprotein autoantibodies, distinguishing this post-infectious parainfectious immune presentation from classic neuromyelitis optica spectrum disorder. Targeted intervention with pulsed high-dose intravenous methylprednisolone sodium succinate, accompanied by gastroprotective prophylaxis, parenteral micronutrient restoration, and structured neuro-rehabilitation, aborted disease progression. Gradual functional restoration culminated in significant motor power recovery and resolution of autonomic sphincter instability at scheduled three-month outpatient surveillance. Neuroaxis magnetic resonance evaluation, disciplined serological differentiation, and early methylprednisolone pulse therapy are important in preserving neurological parenchyma and securing favorable ambulatory outcomes