Pharmacotherapeutic Management of Idiopathic Longitudinally Extensive Transverse Myelitis in a Young Adult: A Case Report

Abstract

Background: Longitudinally extensive transverse myelitis (LETM) is a rare inflammatory disorder of the spinal cord characterised by lesions extending across three or more contiguous vertebral segments. Early diagnosis and prompt initiation of immunosuppressive therapy are essential to prevent permanent neurological deficits. Objective: This case report describes the successful pharmacotherapeutic management of idiopathic LETM in a young adult and highlights the contribution of multidisciplinary care, including clinical pharmacy services. Case Summary: A 19-year-old male presented with a one-week history of high-grade fever, abdominal pain, constipation, nausea, headache, and generalised weakness, followed by acute onset of numbness of the lower trunk and both lower limbs with urinary retention. Neurological examination revealed lower-limb weakness, hypotonia, brisk deep tendon reflexes, and absent plantar responses. Magnetic resonance imaging demonstrated longitudinal intramedullary T2 hyperintense lesions extending from C7 to D10 with additional cervical cord involvement. Cerebrospinal fluid analysis showed lymphocytic pleocytosis and elevated protein levels, while aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies were negative, confirming idiopathic LETM after exclusion of other causes. The patient received intravenous methylprednisolone (1 g/day for seven days), thromboprophylaxis, neurotropic vitamin supplementation, supportive pharmacotherapy, and early physiotherapy. Progressive improvement in motor power, sensory deficits, and bladder function was observed during hospitalisation, and the patient was discharged on oral corticosteroids with rehabilitation advice. Conclusion: This case highlights the importance of early recognition, comprehensive diagnostic evaluation, timely corticosteroid therapy, and multidisciplinary management in achieving favourable neurological outcomes in idiopathic LETM. Clinical pharmacist involvement played a valuable role in optimising pharmacotherapy, monitoring treatment safety, and supporting patient recovery.