INTRODUCTION:
Tuberculosis remains a significant global health burden, with central
nervous system (CNS) involvement being a rare but serious manifestation.
While pulmonary tuberculosis is the most common form, extrapulmonary
manifestations can affect various organs and systems. The CNS
involvement in developing countries constitutes nearly 10% of all
tuberculosis patients [1]. Tuberculomas with compressive
myelopathies without bone involvement are an even rarer occurrence. In
the differential diagnosis of extensive spinal cord injuries,
particularly in young patients with a history of pulmonary tuberculosis
or tuberculous meningitis, it is important to consider the possibility
of an intradural extramedullary tuberculoma [2].
Here we will be discussing a case of intradural extramedullary
tuberculosis of the thoracic spine, with progressive neurological
dysfunction. Surgery aims to decompress the spinal cord and remove the
tuberculoma, thereby relieving the pressure on the neural tissues and
preventing further neurological deterioration [3-5]. The specific
surgical technique employed depends on the location and extent of the
tuberculoma.
Following surgery, anti-tubercular therapy is initiated to target the
underlying tuberculosis infection. This typically involves a combination
of multiple anti-tuberculosis medications, such as isoniazid,
rifampicin, ethambutol, and pyrazinamide [2]. The duration of
anti-tubercular therapy may vary but generally lasts several months to
ensure complete eradication of the infection. Continual postoperative
monitoring assumes paramount importance in assessing neurological
recovery and treatment response. Concurrently, physiotherapy and
rehabilitation assume significance in facilitating the functional
restoration and enhancing the overall quality of life [1].
This report aims to discuss the diagnostic challenges, treatment
strategy, and clinical outcomes, highlighting the importance of a
multidisciplinary approach in managing this uncommon condition.