Multiple Intracranial Tuberculomas with an Intra-medullary Spinal Cord Tuberculoma in a Pediatric Patient

Sreenath Meegada,Richmond Gyamfi,Vijayadershan Muppidi,Vasuki Dandu,Tejo Challa

doi:10.7759/cureus.7248

Abstract

Central nervous system (CNS) tuberculosis (TB), caused by Mycobacterium tuberculosis (MT), is a severe form of TB, which presents as meningitis, cerebritis, abscesses, spinal tuberculous arachnoiditis, and rarely tuberculomas. CNS TB is prevalent in the underdeveloped or developing world and is common in malnourished, alcoholics, children, young adults, immunocompromised, and cancer patients. Intracranial tuberculomas (ICT) can present with symptoms and signs of focal neurological deficits with or without systemic manifestations. ICT is the least common presentation of CNS TB. Medical management with anti-TB drugs and steroids is the mainstay of treatment, while surgical intervention is usually reserved for refractory cases. Here, we present the case of a 10-year-old Indian American girl with headaches, diplopia, fever, and neck pain diagnosed with ICT and intramedullary spinal cord tuberculoma.

Highlights

Central nervous system (CNS) tuberculosis (TB) is a rare form of TB due to the hematogenous spread of Mycobacterium tuberculosis (MT) from the primary site [1]
Central nervous system (CNS) tuberculosis (TB), caused by Mycobacterium tuberculosis (MT), is a severe form of TB, which presents as meningitis, cerebritis, abscesses, spinal tuberculous arachnoiditis, and rarely tuberculomas
We present the case of a 10-year-old Indian American girl with headaches, diplopia, fever, and neck pain diagnosed with Intracranial tuberculomas (ICT) and intramedullary spinal cord tuberculoma

Summary

Introduction

Central nervous system (CNS) tuberculosis (TB) is a rare form of TB due to the hematogenous spread of Mycobacterium tuberculosis (MT) from the primary site [1] It continues to be a prevalent endemic problem in underdeveloped and developing nations [1]. A 10-year-old Indian American girl born in the United States presented with a two-week history of intermittent headaches, fever, neck pain, and transient double vision. She described her headache as global, intermittent, throbbing in nature, non-radiating, with no relieving factors. MRI spine revealed a 9-mm enhancing lesion too (Figure 2) Considering her travel history to India, CNS tuberculoma was high on the differential. She was initiated on four drugs (isoniazid, rifampin, pyrazinamide, ethambutol) and steroid taper with significant improvement in her lesions after five months of treatment, which was evidenced in repeat MRIs (Figures 5-6)

Discussion

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Disclosures