急性脊髓炎（myelitis）是指脊髓的一種非特異性炎症病變，多發生在感染之後，典型的特徵為兩側性運動、感覺和自主神經的障礙，包括下肢運動功能不良、皮膚感覺異常、括約肌控制的損傷（大小便失禁或困難）等。腹壁疼痛是分佈在腹肌的神經受到干擾所致，疼痛並非源自臟器而是源自腹壁。急性脊髓炎是一種少見的神經科疾病，且以腹壁疼痛為初期表徵者並不多見，因此容易被忽略甚至延誤診斷及治療；本文報告一位以腹壁疼痛為初期表徵，在疾病初期遭誤診為腸胃炎及泌尿道感染的急性脊髓炎少見病例。希望藉此病例及文獻回顧，能讓基層醫師對此一少見病症有較深入的了解，並藉以保持高度的警覺性，以期達到早期發現早期治療之預防醫學真諦。（台灣家醫誌2010; 20: 46-51） Acute myelitis is a pathogenetically heterogeneous inflammatory disorder of the spinal cord. Clinical symptoms of myelitis usually evolve subacutely over hours or days as paraparesis, sensory levels, or sphincter dysfunction. Acute transverse myelitis is a rare syndrome, especially presenting with abdominal wall pain which could be easily misdiagnosed at the disease onset. We report a case of acute myelitis presented with abdominal wall pain as an initial manifestation and was misdiagnosed as gastroenteritis and urinary tract infection at onset. (Taiwan J Fam Med 2010; 20: 46-51)