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Coxiella (Q fever)-associated myelopathy

Departments of Neurology (Drs. Hwang and M.C. Lee) and Radiology (Dr. Suh), Asan Medical Center, Ulsan University, and the Department of Microbiology (Dr Lee), Yonsei University College of Medicine, Seoul, Korea.

We describe six men with a slowly progressive myelopathy characterized by asymmetric, incomplete spinal cord syndrome manifested with a thoracic sensory level, mild spastic paraparesis, and urinary incontinence. The spinal cord lesions were evident by MRI in four of them. Coxiella burnetii infection was confirmed in the blood of all patients by immunofluorescence microscopic assay (IFA) and transmission electron microscopy (TEM). In two patients, we detected C burnetii by TEM and IFA using CSF from the patients inoculated onto fresh peripheral blood lymphocyte. Four patients, treated with appropriate antibiotics, responded either with partial resolution of symptoms or arrest of further neurologic progression. In three, the MRI lesions decreased in size.

Address correspondence and reprint requests to Dr. Youn M. Hwang, Department of Neurology, Asan Medical Center. Ulsan University. Kang-Dong P. O. Box 145, Seoul 134-600, Korea.

Received March 19, 1992. Accepted for publication in final form June 16, 1992.