Intradural, Eextramedullary Tuberculoma of the Spinal Cord as a Complication of Tuberculous Meningitis

Abstract

An unusual case of an intradural, extramedullary spinal cord tuberculoma, as a complication of tuberculous meningitis caused by a strain susceptible to major anti-TB drugs, is described in a previously healthy, HIV-negative, 27-year-old male. The tuberculoma was detected by magnetic resonance imaging (MRI) while the patient was under conventional anti-tuberculous (anti-TB) therapy. Histopathology confirmed the diagnosis. Despite the anti-TB treatment and the surgical resection, intramedullary spreading occurred. Finally, a favorable response was achieved by prolongation of treatment accompanied by the administration of ofloxacin and cycloserine.

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

“…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.…”

“…7 From 1980 to 2005, only 22 cases of intradural extramedullary TB have been reported in the world. 6 All of these cases were from outside North America primarily in young HIV-negative patients. 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.…”

“…4,3 In contrast, patients in the third group paradoxically develop intradural pathology only after the initiation of anti-tuberculosis medications. 4,3,9,6,10 Luo et al reported a case of intradural TB in a HIV-negative patient with no known primary infection and no risk factors for exposure. 4 Similarly, Compton et al reported an unusual case of intradural tuberculoma in the cervical spine identified in a healthy HIV negative male after a trivial car accident.…”

“…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. While spinal tuberculomas have been previously described, no prior author has reported a tuberculoma several years after successful eradication of the pulmonary infection.…”

Brainstem Tuberculoma Presenting As Stroke

“…About 10% of pulmonary Koch's patients develop central nervous system tuberculosis (CNS TB). It can present as lesions in brain or spine [2][3][4]. Tuberculoma, an uncommon manifestation of CNS TB usually causes seizures and focal signs.…”