Longitudinally-extensive transverse myelitis in the setting of recent Mycoplasma infection: Case series.

Longitudinally-extensive transverse myelitis (LETM) is a rare but serious inflammatory myelopathy, often presenting with broad neurological symptoms with numerous possible etiologies that pose diagnostic and therapeutic challenges. Here we report three pediatric cases of aggressive LETM with recent Mycoplasma pneumoniae (M. pneumoniae) infection. All patients presented with rapid-onset lower extremity weakness and varying degrees of sensory changes and autonomic dysfunction. MRI confirmed extensive and expansile spinal cord lesions in each case. While M. pneumoniae throat nucleic acid amplification test (NAAT) was positive in all cases, CSF PCR was negative in two (and not performed in the third), raising the question of causality. Treatment regimens and functional outcomes varied, where one patient experienced persistent paraplegia. These cases highlight the potential association between M. pneumoniae and LETM, the diagnostic challenges posed by overlapping infectious and autoimmune features, and the need for early, aggressive treatment. Further research is needed to clarify the pathogenesis of this condition in order to optimize treatment and patient outcomes.