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      Intradural Extramedullary Tuberculoma Masquerading En Plaque Meningioma

      case-report

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          Abstract

          Extensive en plaque intradural extramedullary tuberculomas can occur as a paradoxical response to chemotherapy for intracranial tuberculomas. We report a case of 31-year-old male who presented with backache and progressive weakness and urgency of micturition. Magnetic resonance imaging dorsolumbar spine which showed an ill-defined T1 hypointense and T2 heterointense lesion noted posterior to the thoracic spinal cord, extending from C7 to D5 vertebral levels suggestive of en plaque meningioma. The patient underwent D1-D5 laminectomy, with subtotal debulking of the tumor. The histopathological examination of lesion was suggestive of granulomatous inflammation with multinucleated and Langhan type giant cells confirming the diagnosis of tuberculoma.

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          Most cited references21

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          Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS.

          Transient worsening of tuberculous symptomatology and lesions following antituberculous therapy (paradoxical response) has previously been described as a rare occurrence. To determine the incidence of paradoxical responses in patients with AIDS and TB who are treated with antituberculous therapy and subsequently with combination antiretroviral therapy (ARV), we conducted a prospective study of 33 HIV-seropositive TB patients treated with anti-TB therapy and antiretroviral therapy (Group 1) compared with 55 HIV-seronegative TB patients treated with anti-TB therapy (Group 2) and 28 HIV-seropositive TB patients treated with anti-TB therapy but not on antiretrovirals (historical control; Group 3). In Group 1 patients, paradoxical responses were temporally more related to the initiation of ARV than to the initiation of anti-TB therapy (mean +/- SD: 15 +/- 11 d versus 109 +/- 72 d [p < 0.001]) and occurred much more frequently (12 of 33; 36%) compared with Group 2 (1 of 55; 2%) (p < 0.001) or with Group 3 (2 of 28; 7%) (p = 0.013). The majority of patients who experienced paradoxical responses and received tuberculin purified protein derivative (PPD) in Group 1 had their tuberculin skin tests convert from negative to strongly positive after ARV. These observations suggest that a paradoxical response associated with enhanced tuberculin skin reactivity may occur after the initiation of ARV in HIV-infected TB patients. Furthermore, the skin test conversion after the initiation of ARV may have important public health implications.
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            Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients

            M Turgut (2001)
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              Surgery for intramedullary tuberculoma of the spinal cord: report of 2 cases.

              Intramedullary tuberculomas are rare. With the widespread availability of MRI and the increasing incidence of HIV and HIV-related tuberculous infections, the incidence of these lesions is likely to increase worldwide. The role of medical and surgical treatment of these relatively rare lesions remains to be defined. We report 2 patients who presented with intramedullary tuberculomas and discuss the importance of early surgery in this condition. Two female patients presented with insidious onset of myelopathy. The first patient had seizures due to imaging-documented intracranial tuberculomata and progressive paraparesis due to an intramedullary tuberculoma. The second patient had also had insidious onset of myelopathy and evidence of an intramedullary tuberculoma in MRI. She was also found to have abdominal and pulmonary tuberculosis. In view of the presence of tuberculosis elsewhere in the body in both the patients and the classical imaging features of intramedullary tuberculoma, they were treated initially with antituberculous chemotherapy. However, despite chemotherapy, both patients did not show improvement. Subsequently, both patients underwent microsurgical removal of the intramedullary lesions. The first patient who was neurologically well preserved at the time of surgery improved, whereas the second patient who was paraplegic with sphincter disturbances did not show any improvement. These case reports are presented to highlight the role of early surgery in patients with profound neurological deficits and intramedullary tuberculoma even if the radiological appearance of the lesion is characteristic. Even in lesions that are potentially curable by chemotherapy, early surgery has an important role in the treatment.
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                Author and article information

                Journal
                Asian J Neurosurg
                Asian J Neurosurg
                AJNS
                Asian Journal of Neurosurgery
                Medknow Publications & Media Pvt Ltd (India )
                1793-5482
                2248-9614
                Jul-Sep 2018
                : 13
                : 3
                : 928-930
                Affiliations
                [1] Department of Radiology, Narayana Medical College, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
                [1 ] Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
                [2 ] Department of Pathology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
                [3 ] Neurosurgery-Critical Care, Red Latino, Organización Latinoamericana De Trauma Y Cuidado Neurointensivo, Bogota, Colombia
                Author notes
                Address for correspondence: Dr. Amit Agrawal, Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh, India. E-mail: dramitagrawal@ 123456gmail.com
                Article
                AJNS-13-928
                10.4103/ajns.AJNS_116_18
                6159101
                30283585
                7fd56548-0825-4c57-8e1a-61439ea64ea7
                Copyright: © 2018 Asian Journal of Neurosurgery

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Case Report

                Surgery
                en plaque meningioma,en plaque tuberculoma,paradoxical response introduction tuberculosis

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