Coexisting spinal intramedullary and intracranial tuberculomas in an immunocompetent child

Abstract

Pediatric neurotuberculosis manifests commonly as tuberculous meningitis and intracranial tuberculomas. The ratio of occurrence of intracranial to intraspinal tuberculoma reported is 42:1. Intramedullary tuberculomas (IMTs) are rare, and the coexistence of intramedullary and intracranial tuberculoma is extremely rare. We report a case of coexisting intramedullary and intracranial tuberculoma in a 5-year-old boy who presented with fever for 12 days, progressive motor weakness in the lower limbs for 9 days, and retention of urine and constipation for 6 days. Neurological examination revealed signs of compressive myelopathy. Magnetic resonance imaging (MRI) of the spine detected IMT at D4-D5 level of the thoracic cord with perilesional edema. MRI of brain revealed a right frontal tuberculoma. Medical management with antituberculosis therapy and steroids resulted in complete neurological recovery.

Spinal intramedullary tuberculoma in a 3-year-old girl

“…[4] As indicated in the present case and previous pediatric reports, the influence of the Bacille Calmette-Guerin vaccine in the prevention of spinal IMT is questionable. [5,17] MRI is the imaging modality of choice for spinal IMT. [11] Radiological findings of the spine may vary depending on the phase of illness, translating to differing levels of intensities seen on T1W and T2W sequencing.…”

“…[ 4 ] As indicated in the present case and previous pediatric reports, the influence of the Bacille Calmette–Guerin vaccine in the prevention of spinal IMT is questionable. [ 5 , 17 ]…”