Intra-medullary tuberculoma of the spinal cord presenting with typhoid and paraplegia: a case report

Abstract

IntroductionIntra-medullary spinal tuberculoma is a rare form of tuberculosis, with an incidence of only two in 100,000 patients with tuberculosis. We present a case of intra-medullary tuberculoma from Pakistan, which was diagnosed by radiological findings and analysis of cerebrospinal fluid using polymerase chain reaction testing.Case presentationWe present the case of a 28-year-old Sindhi male with intra-medullary tuberculoma of the spinal cord at the C3 level. Our patient was treated solely with anti-tubercular drug therapy with no surgical intervention.ConclusionsWe discuss the possible clinical management of such rare cases, considering both chemotherapeutic and surgical options. Additionally, diagnostic procedures and findings are discussed; we suggest cerebrospinal fluid analysis via polymerase chain reaction and gadolinium-diethylenetriamine pentaacetic acid magnetic resonance imaging as important chemical and radiological tests to be performed in such cases.

Intramedullary Tuberculoma after Tuberculous Meningitis —A Rare Case with an Uncommon Radiological Presentation

“…1,2,4-7 Among these, spinal cord injuries occur in less than 8% of patients, and tuberculomas, even rarer, occur in 2 cases per 100,000 diagnosed with systemic tuberculosis, and 1,000 with CNS tuberculosis. 2,3,[6][7][8][9][10] Pott disease, spinal arachnoiditis, and other lesions appear more frequently. The thoracic spine accounts for 72% of spinal cases, and in 69% of cases there is concomitant pulmonary tuberculosis.…”

“…[1][2][3]5,6,8 Compared with cerebral damage, spinal cord injury occurs in a proportion of 1/42, the data that relate to the ratio of spinal cord and brain weight, which is 1/47, suggesting a relationship between infectivity and density of neural tissue. 6,7,9 The formation of tuberculoma, in most cases, is induced by hematogenous spread from a systemic focus of deficits or for diagnostic confirmation. Although benign and potentially curable, intramedullary tuberculoma should be promptly diagnosed and treated to prevent irreversible damage.…”

“…► tuberculose ► meningite tuberculosa ► tuberculoma intramedular ► tuberculoma medular tuberculosis and, more rarely, by direct contamination of neural tissue through cortical veins and penetrating artery in cases of tuberculous meningitis, as described by many authors. 5,9,10 The clinical presentation is marked by progressive subacute spinal cord compression with weakness in the lower limbs, which may cause flaccid or spastic paraplegia, paresthesias, urinary and fecal incontinence, and sensory level. 6,8 By being unspecific, physicians should be aware for possible differential diagnoses such as spinal tumors and Pott disease, more common than tuberculoma.…”

“…When it becomes liquefied, the center of the granuloma shows hypointense signal on T1W and hyperintense on T2W, with ring enhancement. [3][4][5][6]8,9 Thus, we perceive the difference between the radiographic pattern of tuberculoma and the evidence in the author's case, which makes the diagnosis and therapeutic decision a challenge.…”