CASE PRESENTATION: A 36 year old male with no past medical history presented to the emergency department referred from the neurology clinic for work-up of acute urinary retention , saddle anesthesia and bilateral lower extremity numbness of 4 weeks duration. Case Presenter:Yazmin Heredia I am an International Medical Graduate, amateur gardener and language learner, passionate about Medical Education, with a special love for Infectious diseases #IDLove
Neurologic examination on admission revealed 3+ symmetric throughout reflexes . Sensory examination revealed loss of light touch and pinprick sensations on the bilateral soles.
CBC and BMP: within normal limits. A lumbar puncture was performed and showed an elevated CSF protein level of 64, WBC 65, and 88% of lymphocytes, IgG 8.4; CSF gram stain and culture for bacteria, mycobacteria, and fungi were negative. Blood cultures and serological evidence for infection by VZV, HSV-1, HIV, CMV, and Syphilis were negative, and HSV-2 IgG was positive . MRI showed extensive stable dorsolateral intramedullary enhancing lesions involving the visualized cervical and entire thoracic cord . The patient received three doses of acyclovir 800 mg IV every eight hours and methylprednisolone 1 g daily for five days. His urinary retention improved on his fourth day of admission and the urinary catheter was removed. He was discharged afterwards, asymptomatic.
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