Acute transeverse myelitis has been recognized as a clinical entity for several decades. Nevertheless it remains a poorly understood syndrome, not only etiologically but also in terms of its clinical behavior. Described here a case of this syndrome in which the cause was shown to be typhoid fever. A 30-year-old house wife was admitted to the Severance Hospital, Yonsei University College of Medicine on July 8, 1975. For ten days previously she had felt generally unwell with a high fever and headache. Four days before admission she had begun to notice reddish urine and suffred from nausea and vomiting. On examination, she was febrile (39.6). Sclera was icteric and liver was palpated 3cm below the right costal margin. The hemoglobin was 10.8grn%. WBC 7, 050/mm3, stool occult blood -+, urine ´,urobilinogen. 1 : 640, total protein 6.6gm% (albumin 3.4gm%), total bilirubin 2.7mg%, total cholesterol 163mg%, SGOT 130 unit, SGPT 96 unit, alkaline phosphatase 6. 6 .S. U. and prothrombin time 88% of normal. S. typhi were isolated from blood and´, stool culture. HB Ag and alpha-€etoprotein were negative and liver scanning revealed moderate hepatpcellular dysfunction with slight splenic uptake. These findings confirmed the diagnosis of typhoid fever. She was treated with chloramphenicol 3.0gm and ampicillin 2.0gm daily from the day of admission. On the 9th hospital day she felt paresthesia of lower limbs and urinary difficulty, and on the 11th hospital day she was unable´, to move his lower extremities and spontaneous voiding was impossible. Neurological examination revealed questionable neck stiffness, sensory loss below´´ the T-5 level, and paraplegia with hyperactive tendon reflexes and extensor plantar responses. X´-ray of the spine and Wassermann reaction were normal. The spinal fluid examination was normal except 69mg% protein and 71 lymphocytes per cubic millimeter.
Proper care of bladder -and´, bowel, good nursing management, use of antibiotics such as chloramphenicol and ampicillin, and prednisolone had brought rapid improvement and the patient became ambulatory ten days after onset. Neurological assessment at this stage showed no deficit and a repeated cerebrospinal fluid examination was normal. She was discharged with chloramphenicol 2.0gm, ampicillin 2.0gm and prednisolone 2.0mg daily on the 21th day of admission.
With the best of our knowledge, this may be the first report of a case of acute transeverse myelitis complicated in typhoid fever ´,in this country.
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