Intradural Extramedullary Spinal Tuberculosis Diagnosed Eight Years After Treatment of the Primary Infection: A Case Report.

Abstract

Tuberculosis (TB), the disease caused by Mycobacterium tuberculosis, is the second leading killer worldwide from a single infectious agent. Spinal TB is associated with pulmonary disease and may originate from hematogenous spread outside the central nervous system, sites located within the cranium (meningitis), or secondary extension from vertebral bodies or discs (Pott disease)1. Other presentations of tuberculosis include tuberculous arachnoiditis, nonosseous spinal tuberculoma, and spinal meningitis. Of these conditions, spinal tuberculoma can be intradural, extradural, intramedullary, or extramedullary. Intradural extramedullary tuberculosis is the most rare type and is only observed in one of 50,000 cases of tuberculosis2,3. To the best of our knowledge, in North America there has only been one previously documented intradural extramedullary tuberculoma in a patient who is not infected with human immunodeficiency virus (HIV)4. Intradural spinal tuberculomas often present simultaneously with, or are preceded by, tuberculous meningitis5,6. We treated an otherwise healthy man who developed progressive lower-extremity pain and weakness from an intradural spinal tuberculoma. While spinal tuberculomas have been previously described2-10, to our knowledge, there have been no reports of a tuberculoma several years after successful eradication of the pulmonary infection. In this report, we present the case, pertinent imaging, operative findings, histopathology, and a review of the literature. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A sixty-eight-year-old man presented with a four-month history of progressive low back pain, lower-extremity weakness on the left side, and radiculopathy (pain level, 7 of 10), which became worse with activity. There was no history of trauma, bowel or bladder incontinence, balance problems, neck pain, or upper-extremity symptoms. Past medical history was noteworthy for diabetes mellitus, diabetic neuropathy, and tuberculosis, which had …