Objective: Myoclonus associated with tuberculosis or following an infectious event is a transient event with an abrupt onset. It is a rare phenomenon and often not recognized. In these reports, its clinical features and its favourable outcome are described.

Background: A 34-year-old lady without medical illness presented with headache for one month, whole body tremulousness for ten days followed by lower limb weakness for two days duration. She has no infectious and constitutional symptoms. Her drugs and family history were unremarkable.

Method: A case report.

Results: Examination revealed normal mental status and presence of diffuse polymyoclonus predominantly affecting the upper limbs and face with loss of limbs dexterity. There were left six nerve palsy in addition to flaccid paralysis with areflexia.  Investigations have shown normal blood counts, with high erythrocyte sedimentation rate (108 mm/hr) and normal CT brain findings. Therefore, lumbar puncture was performed which demonstrated high opening pressure (33cmH20), high protein content (1.8 mg/L) and low glucose ratio (0.38) with lymphocyte predominant. Surface electromyography confirmed repetitive and non-rhythmic discharges of less than 50 milliseconds typical of myoclonus. Further investigations including autoimmune, paraneoplastic screening, CT thorax,abdomen and pelvis as well as  PET scan were non-significant. MRI of the brain showed unspecific leptomeningeal enhancement of right frontal, periventricular,perivascular space and prepontine cisterns consistent with meningoencephalitis. MRI T2 and STIR sequence showed diffuse patchy hyperintensity within the whole spinal cord suggestive of tranverse myelitis. In view of the above findings and positive TB PCR taken from cerebral spinal fluid, she was prescribed anti tubercular drugs and has shown clinical and radiology improvement with disappearance of tremulousness after two months of treatment.

Conclusion: This case highlights generalised polymyoclonus as a benign phenomenon that could occur following tuberculosis infection. Early recognition may avoid treatment delay and unnecessary investigations.

References: Alarcón, F., Dueñas, G., Cevallos, N., & Lees, A. J. (2000). Movement disorders in 30 patients with tuberculous meningitis. Movement disorders: official journal of the Movement Disorder Society, 15(3), 561-569.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/generalised-polymyoclonus-in-a-patient-with-central-nervous-system-tuberculosis/