Journal of neuroimmunology · 2026
Para infectious myelitis with Conus medullaris immunotropism in the immune phase of leptospirosis infection: Clinical pattern and in silico molecular mimicry analysis based biological plausibility.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Saranya Nelabhotla Sai Satya, Ramesh Rithvik, Krishnamoorthy Vengadakrishnan, Ranganathan Lakshmi Narasimhan, Shanmugam Sundar, Hazeena Philo, Todur Vivek Nagaraj
Аннотация
BACKGROUND: Neurological involvement in leptospirosis but increasingly recognized, with myelitis representing a disabling complication. Conus medullaris involvement has not been systematically described and may reflect region-specific vulnerability to immune-mediated injury, post leptospirosis infection.
METHODS: We report a case series of three patients with serologically confirmed leptospirosis who developed acute myelitis during the immune phase, with radiological involvement of the conus medullaris. Clinical, cerebrospinal fluid, and imaging features were analyzed. A proteome-wide in silico comparison was performed between human myelin oligodendrocyte glycoprotein and the Leptospira interrogans proteome to identify shared antigenic motifs.
RESULTS: All patients presented with acute bladder dysfunction, lower limb weakness, or sensory symptoms following a febrile illness. Magnetic resonance imaging showed conus medullaris involvement, either isolated or as part of longitudinal cord lesions. Cerebrospinal fluid revealed inflammatory changes. Treatment with steroids, with adjunctive immunotherapy in severe cases, resulted in clinical improvement. In silico analysis did not demonstrate full-length homology but identified 19 shared peptide motifs with moderate sequence identity, several overlapping predicted B-cell and T-cell epitope regions.
CONCLUSIONS: This series suggests a possible para-infectious conus-predominant myelitis pattern in leptospirosis. The identification of shared antigenic motifs provides biological plausibility for immune-mediated demyelination through molecular mimicry. Recognition of this pattern in endemic regions may facilitate early diagnosis and timely immunotherapy.
METHODS: We report a case series of three patients with serologically confirmed leptospirosis who developed acute myelitis during the immune phase, with radiological involvement of the conus medullaris. Clinical, cerebrospinal fluid, and imaging features were analyzed. A proteome-wide in silico comparison was performed between human myelin oligodendrocyte glycoprotein and the Leptospira interrogans proteome to identify shared antigenic motifs.
RESULTS: All patients presented with acute bladder dysfunction, lower limb weakness, or sensory symptoms following a febrile illness. Magnetic resonance imaging showed conus medullaris involvement, either isolated or as part of longitudinal cord lesions. Cerebrospinal fluid revealed inflammatory changes. Treatment with steroids, with adjunctive immunotherapy in severe cases, resulted in clinical improvement. In silico analysis did not demonstrate full-length homology but identified 19 shared peptide motifs with moderate sequence identity, several overlapping predicted B-cell and T-cell epitope regions.
CONCLUSIONS: This series suggests a possible para-infectious conus-predominant myelitis pattern in leptospirosis. The identification of shared antigenic motifs provides biological plausibility for immune-mediated demyelination through molecular mimicry. Recognition of this pattern in endemic regions may facilitate early diagnosis and timely immunotherapy.