Intradural Extramedullary Spinal Tuberculosis Diagnosed Eight Years After Treatment of the Primary Infection

Verma, Kushagra; Crothers, Tracey; Neuman, Brian J.; Vaccaro, Alexander; Heller, Joshua

doi:10.2106/jbjs.cc.m.00080

JBJS Case Connector

2013

DOI: 10.2106/jbjs.cc.m.00080

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Intradural Extramedullary Spinal Tuberculosis Diagnosed Eight Years After Treatment of the Primary Infection

Kushagra Verma

Tracey Crothers

Brian J. Neuman

et al.

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Cited by 3 publications

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Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy

Duvuru,

Sanker,

Naureen

et al. 2023

Clinical Case Reports

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Key Clinical MessageAn uncommon form of CNS tuberculosis called non‐osseous IDEM tuberculoma frequently results from paradoxical drug interactions. It should be considered one of the differentials when patients receiving ATT experience acute neurological impairment.AbstractTuberculoma affecting the spinal cord is a rare condition in modern times. The occurrence of non‐osseous intradural tuberculosis, specifically in the spine, is even more exceptional. In fact, it is uncommon to encounter an intradural extramedullary tuberculous granuloma that lacks radiological indications of vertebral involvement, especially within the thoracic region. We present a case of a patient with a neurological deficit caused by a non‐osseous intradural tuberculoma in the thoracic region, without any associated bone involvement. The patient experienced a gradual deterioration of neurological function. An MRI of the thoracic spine revealed the presence of a tuberculoma located intradurally, extramedullary, and juxtamedullary of the T5 vertebra. The compression of the spinal cord resulted in paraparesis which was worsening to paraplegia. A D4–D6 laminectomy and microsurgical excision were performed under intraoperative neurophysiological monitoring (IONM), and the patient showed clinical recovery. Excellent clinical outcomes were achieved. However, it is crucial to consider the possibility of a non‐osseous intradural tuberculoma as a rare condition when encountering a SOL, particularly in patients with a history of tuberculosis and spinal cord compression. In cases where a progressing neurological deficit is present, a combination of surgical intervention and anti‐tuberculous treatment should be considered as the optimal approach.

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Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy

Duvuru,

Sanker,

Naureen

et al. 2023

Clinical Case Reports

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Intradural extramedullary tuberculoma of the thoracic spine – A rare case report of paraparesis

Kangabam

Amataleima

Amitkumar

et al. 2021

Surgical Neurology International

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Background: Intradural extramedullary tuberculoma of the spinal cord (IETSC) is an extremely rare form of spinal tuberculosis (TB) that is believed to be due to a host’s immune reaction against the Mycobacterium protein derivatives. Case Description: A 25-year-old male with human immunodeficiency virus, hepatitis C virus, and disseminated TB on antitubercular therapy for the past 8 months, presented with paraplegia of 2 months duration. When the MRI spine revealed multiple peripheral rim enhancing intradural extramedullary lesions from T6 to T8 and dorsally from T10 to T11, the patient was diagnosed with IETSC. At surgery, we countered cystic lesions adherent to the dura and the spinal cord, containing a whitish material. Postoperatively, the patient showed clinical improvement in motor power and sensation. Conclusion: Intradural extramedullary spinal tuberculomas in patients with a history of TB and spinal cord compression, although rare, should be considered among the differential diagnoses.

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Delayed Presentation of Intradural Extramedullary Tuberculoma of Spine in an Immunocompetent MDR-TB Patient

Saurabh,

Nallathambi

2024

Indian Spine J

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Intradural spinal tuberculoma is a rare entity, constituting <5% of CNS tuberculoma, whereas intradural extramedullary tuberculoma of spinal cord (IETSC) is even less frequently encountered. Here, we report a case of IETSC at two noncontiguous levels in spinal cord presenting with compressive myelopathy in a patient on multidrug-resistant tuberculosis (MDR-TB) treatment. Surgical decompression and appropriate ATT regimen resulted in gradual return to near-normal neurological function with no functional disability. To our knowledge, this is the first case report of IETSC developing in an immunocompetent patient on MDR regimen for drug resistant sputum-positive pulmonary tuberculosis.

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Intradural Extramedullary Spinal Tuberculosis Diagnosed Eight Years After Treatment of the Primary Infection

Cited by 3 publications

References 14 publications

Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy

Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy

Intradural extramedullary tuberculoma of the thoracic spine – A rare case report of paraparesis

Delayed Presentation of Intradural Extramedullary Tuberculoma of Spine in an Immunocompetent MDR-TB Patient

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