| CASE REPORT |
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| Year : 2023 | Volume
: 13
| Issue : 2 | Page : 113-117 |
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Intramedullary tuberculoma of the conus medularis in an immunocompetent young adult with no pulmonary tuberculosis, the challenges of diagnosis and management: A case report and review of literature
Jeneral Dumura Alfin1, Philip Ojile Akpa2, Danaan Joseph Shilong1, Gyang Markus Bot1, Onyemaechi Ereke Nwibo1, Nanapan Isa Kyesmen1, Shina Abidemi Olalere1, Nenkimum Dirting Bakwa1, Innocent Emmanuel2
1 Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
2 Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Jos, Nigeria
Correspondence Address:
Dr. Jeneral Dumura Alfin
Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jwas.jwas_201_22
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Background and Objective: Intramedullary tuberculoma (IMT) of the conus medullaris is an extremely rare tumour that constitutes a diagnostic and management challenge in a resource-limited setting. We report a case of conus medullaris, IMT in a young immunocompetent, patient with no prior clinical features of pulmonary or extra-pulmonary tuberculosis. Case Summary: The patient presented with six months history of progressive and persistent mid back pain and slight weakness of both lower limbs of 3 months duration. Physical examination revealed a well-nourished man with power of 3/5 and hyperreflexia on both lower limbs. Chest radiograph and other investigations for tuberculosis were negative. Magnetic resonance imaging (MRI) of the lumbosacral spine showed fusiform expansion of the conus medullaris, with a well circumscribed, ring enhancing, intramedullary mass straddle between T12 and L1. Patient had gross total resection with no intraoperative monitoring assistance and no post-operative worsening of neurological function. Histology showed granulomatous lesion with central caseation in keeping with a tuberculoma. Patient was commenced on post-operative anti-tuberculous therapy with physiotherapy, with full motor recovery at six months post-surgical intervention and anti-tuberculous therapy. Conclusion: Intramedullary tuberculoma can be considered as one of the differential diagnoses of intradural, intramedullary tumour of the conus, even in immunocompetent individual with no clinical features of tuberculosis. |
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