Tuberculoma of the Cervical Spinal Canal Mimicking En Plaque Meningioma

Abstract

A previously healthy, HIV-negative, 40-year-old man presented with a 2-month history of progressive weakness of his left arm. Magnetic resonance imaging revealed an intradural, extramedullary plaque-shaped lesion at C6-T1 levels with high contrast enhancement. Based on the patient's clinical and radiologic findings, it was believed that the patient had an en plaque meningioma, and he was operated on. Histologic examination of the mass revealed granulomas with multinucleated and Langhans-type giant cells, typical of a tuberculoma. Intradural extramedullary tuberculomas should be considered in the differential diagnosis of en plaque meningioma as a rare entity.

A Case of Intradural Extramedullary Spinal Tuberculosis Diagnosed 8 Years After Treatment of the Primary Infection

“…Acid fast staining and intra-operative cultures were positive. 8,4 Similarly, Mirzai et al reported intradural tuberculosis in a young healthy patient with no prior history of pulmonary TB. In this case, histology revealed granulomatous inflammation and giant cells, which were suggestive, however, acid-fast staining and intra-operative cultures were negative.…”

“…The mechanism is poorly understood, however interplay between the bacteria and the host's immune system may be responsible for this finding. 4,6 Tuberculomas may also represent a granulomatous healing response rather than a true bacteriologic reactivation. 9 surrounded by granulomatous tissue", however acid-fast staining and intra-operative cultures were negative.…”

“…To date, there has only been one reported case of intradural extrameduallary TB reported in North America in the last 30 years, our case being the second. 4 Among adult patients with intradural extramedullary TB, there appear to be three variants: (1) healthy patients with no prior history of primary TB, (2) patients with disseminated TB elsewhere in the body, (3) and those patients with a recent history of TB treated successfully with medical therapy. In the first group, acid-fast staining and operative cultures are positive and strongly suggestive of the disease.…”

“…In our review, there have only been three case reports in this group. 8,4,2 The second group is the largest, and may include HIV positive patients on retroviral therapy. 4,3 In contrast, patients in the third group paradoxically develop intradural pathology only after the initiation of anti-tuberculosis medications.…”

“…2,3 To date, there has only been one documented intradural extramedullary tuberculoma in a non-HIV-infected patient in North America. 4 Intradural spinal tuberculomas often present simultaneously or are preceded by tuberculous meningitis (TBM). 5,6 We treated an otherwise healthy 68-yearold male that developed progressive lower extremity pain and weakness from an intradural spinal tuberculoma.…”