Cerebrospinal fluid profiles in gray matter myelitis were indistinguishable from CSF profiles in bacterial meningitis, although none of the patients had meningeal signs or positive bacterial, viral, or fungal cultures.
If obtaining an MRI is not feasible, Dr. Birnbaum said,. “the spinal tap can support evidence of gray matter myelitis.”
He added that in cases in which the differential includes both meningitis and myelitis, concomitant administration of corticosteroids and antibiotics is appropriate. Both are commonly administered for worsening TB meningitis in order to simultaneously eliminate the infection and quiet the cytokine storm it produces.
In all, 12 MRIs were available for patients with gray matter myelitis, and 23 for patients with white matter myelitis.
Cord swelling was seen in 91.7% (11) of the gray matter MRIs and in 21.7% (5) of the white matter images; postgadolinium enhancement was seen in 25% (3) of the gray matter MRIs and in 42.9% (10) of white matter images.