CASE REPORT:
A 29-year-old man, who had been under treatment for disseminated tuberculosis for seven months, was admitted with progressive weakness of both lower limbs leading to difficulty in walking. There was no history of fever, cough, palpitations, or breathlessness. Physical examination revealed a palpable spleen but no lymphadenopathy. He had spastic paraparesis with involvement of right side more than the left. There was severe girdle pain at T5 level. The patient underwent a computed tomography (CT) chest, which revealed multiple patchy resolving ground glass opacities and interlobular septal thickening in bilateral lower lobes, predominantly superior and posterior basal segments, suggesting resolving tuberculosis. Also, mild centrilobular emphysema in bilateral upper lobes with sub-centimeter right paratracheal and left paraaortic lymph nodes, the largest measuring 7 mm, were present. Other findings included splenomegaly measuring 17.6 cm and calcified hepatic granulomas (segment VII).
Magnetic Resonance Imaging (MRI) thoracic spine revealed a single 2.1 *1.7 * 1.45 cm intradural/juxta medullary and extramedullary mass appearing as well-defined T1-weighted low signal/ T2-weighted FLAIR bright signal with central necrosis and marginal enhancement after gadolinium (Gd) suggestive of immature tuberculoma at T5 level with surrounding edema (Figure 1: A, B, & C ).