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 ).