Case report

A 58-year-old man initially noticed an abnormal sensation around the abdomen and weakness of the legs, making it difficult for him to finish a round of golf. Two months later, he developed sudden weakness of the left face and hand, with abnormal sensation of the upper lip. He was admitted to the local hospital. An MR scan of brain showed an acute infarction in the right centrum semiovale; he was started on stroke prevention therapy. One month later, he was re-admitted with a 2-week history of gradual onset bilateral lower limb weakness, paraesthesia and urinary retention. MR scan of spine showed a hyperintense contrast-enhancing, intramedullary lesion between T6 and T10, thought to represent either ischaemia or demyelination (figure 1). Despite starting corticosteroids, he continued to deteriorate, with complete flaccid paraplegia, night sweats and pyrexia.

His erythrocyte sedimentation rate and serum C reactive protein were …