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Review
. 2017 Dec;96(49):e8673.
doi: 10.1097/MD.0000000000008673.

Spinal intramedullary tuberculoma following pulmonary tuberculosis: A case report and literature review

Guan-Chyuan Wang  1 , Sheng-Wen Wu
Affiliations
Review

Spinal intramedullary tuberculoma following pulmonary tuberculosis: A case report and literature review

Guan-Chyuan Wang et al. Medicine (Baltimore). 2017 Dec.

Abstract

Rationale: Spinal intramedullary tuberculoma (IMTB) is a rare disease that accounts for 1 to 2/100,000 patients with tuberculosis. We presented a case with pulmonary tuberculosis and concurrent IMTB at C3 to C5 level and reviewed the recent case series and discussed the diagnosis, treatment, and outcome.

Patient concerns: A 33-year-old male had concurrent pulmonary TB and IMTB at the C3 to C5 level. He had quadriplegia (muscle power 0 at 4 limbs) and sensory loss below C5 level. He also had incontinence, anal tone loss, and paradoxical respiratory pattern.

Diagnosis: Spinal magnetic resonance imaging (MRI) showed a 25 11mm intramedullary lesion at C3/C4 level. Under the impression of IMTB, he underwent surgery.

Intervention: We performed C3 to C5 laminectomy and en bloc removal of the tumor. The patient kept receiving anti-TB medications after the surgery.

Outcome: His 4 limbs muscle power had improved but could not be liberated from the endotracheal tube, so tracheostomy was performed. Muscle power gradually increased to 3 points in his upper limbs and to 2 points in his lower limbs. Sensation in his 4 limbs gradually improved as well.

Lessons: IMTB is a rare disease that should be treated with a combination of medication and surgery. For patients with prominent spinal cord compression and neurological symptoms, early operation to remove the tumor is necessary.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Magnetic resonance imaging (MRI) of the patient: (A) T1WI shows spinal cord swelling. (B) T2WI shows hyperintense lesion at C3 and C4 levels. (C) Contrast-enhanced T1WI shows typical target sign. (D) Axial view of the contrast-enhanced T1WI shows intramedullary lesion.
Figure 2
Figure 2
The postoperative image shows C3–C5 laminectomy and lateral mass screws.
Figure 3
Figure 3
The specimen and the pathology: (A) A 2×2 nodule with central necrosis. (B) The postoperative pathologic results demonstrate centrozonal necrosis, epithelioid histiocytes, and lymphoid hyperplasia.
See this image and copyright information in PMC

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