Intramedullary tuberculoma of the conus medularis in an immunocompetent young adult with no pulmonary tuberculosis, the challenges of diagnosis and management: A case report and review of literature

Abstract

Background and Objective: Intramedullary tuberculoma (IMT) of the conus medullaris is an extremely rare tumour that constitutes a diagnostic and management challenge in a resource-limited setting. We report a case of conus medullaris, IMT in a young immunocompetent, patient with no prior clinical features of pulmonary or extra-pulmonary tuberculosis. Case Summary: The patient presented with six months history of progressive and persistent mid back pain and slight weakness of both lower limbs of 3 months duration. Physical examination revealed a well-nourished man with power of 3/5 and hyperreflexia on both lower limbs. Chest radiograph and other investigations for tuberculosis were negative. Magnetic resonance imaging (MRI) of the lumbosacral spine showed fusiform expansion of the conus medullaris, with a well circumscribed, ring enhancing, intramedullary mass straddle between T12 and L1. Patient had gross total resection with no intraoperative monitoring assistance and no post-operative worsening of neurological function. Histology showed granulomatous lesion with central caseation in keeping with a tuberculoma. Patient was commenced on post-operative anti-tuberculous therapy with physiotherapy, with full motor recovery at six months post-surgical intervention and anti-tuberculous therapy. Conclusion: Intramedullary tuberculoma can be considered as one of the differential diagnoses of intradural, intramedullary tumour of the conus, even in immunocompetent individual with no clinical features of tuberculosis.

Spinal Adhesive Arachnoiditis Following Surgical Treatment for an Intramedullary Tuberculoma of the Conus Medullaris: A Case Report from Western Mexico

“…IMT was first described by Abercrombie in 1828, occurs in 2 out of 1000 cases of TB of CNS and the intracranial tuberculoma to IMT ratio is approximately 42: 1 [5,13]. As in our case, the highest incidence of IMT is found in young people (mean age: 29.7 years) and has been attributed to the reactivation of a previous TB infection by immunodeficiency disorders, although our patient has neither a history of TB nor evidence of immunosuppression [10,14].…”

“…To the date about 175 cases of intramedullary tuberculoma (IMT) have been reported in the literature [5,6,7,8,9]. Given its low frequency, prompt recognition of its clinical and radiological features, in which magnetic resonance imaging (MRI) plays an important role, is of vital importance for the selection of therapeutic interventions and avoid complications [10].…”