Intramedullary granuloma suggestive of tuberculoma

Abstract

.CASEA 26-year-old woman presented with two-month back pain followed by paraparesis. At admission unit, the patient presented with urinary retention and parapa -resis grade II. Magnetic resonance images demonstrated intramedullary lesion, at C7-T1 level, with ring contrast enhancement (Fig 1A, 1B, 1C), and lytic lesion on T8 vertebral body (Fig 1D). The patient tested negative for HIV. In view of the evidence of tuberculosis by the radio -logical appearance in T8 level, a presumptive diagnosis of intramedullary tuberculoma was made, and the pa-tient received chemotherapy. However the neurological deficits worsened and the surgery was planned. A lami-notomy at C7-T1 level was done followed by debulking of the lesion microsurgically.Histopathologic examination revealed lymphocytes, epithelioid cells, and Langerhans giant cells indicative of tuberculoma (Fig 1E, 1F). Cultures were negative and PCR has not been done. Postoperatively, patient showed gradual improvement in power over a period of six months.DISCUSSIONThe common location of intramedullary tuberculoma is the thoracic cord and less commonly in the cervical and lumbar regions. The best imaging modality for diag-nosis is magnetic resonance image