Transverse myelitis and heroin abuse: a case report

The usage of heroin is associated with a variety of neurologic disorders, including acute transverse myelitis. In this study we present a 19 year old man who was suffered from insufflated heroin after several months of abstinence, and admitted to hospital emergency department, unconscious. He responded to fluid therapy and Naloxone, but could not move his legs on examination. He had flaccid paralysis of both legs, acute urinary retention and diminished rectal tone. Deep tendon reflexes were absent with downward plantar reflexes. Analysis of CSF was normal, and the MRI of the spine revealed confluent hyperintensity on T2-weighted images from the C5 to T2 vertebral levels involving the majority of the cord substance. The cord was mildly expanded without any enhancement after Gadolinium injection. Suggested mechanisms of heroin-associated myelopathy include hypotension, a direct toxic effect of heroin, vasculitis, and hypersensitivity reaction. Hypersensitivity was the predominant theory since the initial reports, implied that most patients with developed myelopathy had relapsed into heroin use after a period of abstinence. Treatment with either IV corticosteroids or immunopheresis could blunt the immune response, preventing disability. Efficacy of these methods require more studies in future.