Abstract
Objective: To review a unique case of idiopathic inflammatory spinal cord compression in a patient with newly diagnosed tuberculosis
Background: Spinal cord compression in spinal tuberculosis has characteristic radiographic and pathological findings. In case of atypical presentations, other differential diagnoses have to be evaluated.
Design/Methods: Retrospective review of a case of extramedullary/extradural spinal cord compression in a patient with newly diagnosed tuberculosis
Results: A 43-year old male presented with a 6-month history of progressive bilateral lower extremity weakness and increasing back pain. His clinical examination revealed a strength of 0/5 in bilateral lower extremities and 4-/5 in bilateral upper extremities. There was sensory loss to all modalities below T10 spinal level and reduced sensation was also noted in the C5–C8 dermatomal distribution. Reflexes were 1+ in bilateral upper and lower extremities without pathologic reflexes. MRI revealed two prominent extramedullary/extradural mass lesions (T10/T11 and C3) involving soft tissue, posterior elements and extending into the adjacent epidural region causing cord compression. Patient underwent posterior laminectomy for both lesions and had regained significant strength one month after surgery. During the hospital admission, patient tested positive for tuberculosis despite prior normal screening tests. Biopsy studies of both masses revealed inflammatory infiltrate that was predominantly composed of T lymphocytes with minor components of B lymphocytes and plasma cells without granulomatous changes. Additional special stains by Ziehl-Nelsen acid fast stain and Auramine-rhodamine stain were negative for mycobacterial infection. IgG4 immunostaining was not consistent with IgG4-related hypertrophic spinal pachymeningitis. Work-up for other infections and malignancies was also negative
Conclusions: Spinal cord compression from extradural/extramedullary lesions has a broad differential even for patients with tuberculosis. This case presented with radiological and pathological findings that were atypical for spinal tuberculosis. In case of idiopathic inflammatory compression myelopathy, surgical intervention with close monitoring is warranted to improve functional outcome.
Disclosure: Dr. Agashe has nothing to disclose. Dr. Fang has nothing to disclose.
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