Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6353
Peer-review started: July 3, 2020
First decision: September 24, 2020
Revised: September 27, 2020
Accepted: October 27, 2020
Article in press: October 27, 2020
Published online: December 26, 2020
Tuberculosis (TB) mostly attacks the lungs, and extrapulmonary TB involving the central nervous system is uncommon; among these cases, spinal intramedullary TB is even more rare. The clinical manifestations of spinal intramedullary TB are similar to those of intramedullary spinal cord tumors. Therefore, it is necessary to make a careful differential diagnosis of spinal intramedullary lesions to achieve the appropriate treatment and favorable prognosis. We report a rare case of a young male patient with paraplegia due to spinal intramedullary TB, which is uncommon and regrettable.
A 23-year-old male presented with fever accompanied by nausea and vomiting lasting for 2 mo and was then diagnosed with tubercular meningitis. After anti-TB treatment, his symptoms were significantly improved. However, 2 mo after the diagnosis of tubercular meningitis, the patient felt numbness below the costal arch level, which lasted for 1 wk, and he paid no attention to this symptom. What followed was paraplegia and urine/fecal incontinence. Magnetic resonance imaging of the thoracic spine showed a ring-enhanced intramedullary cord lesion at T8-T9. Lesion exploration showed enlargement of the spinal cord at T8-T9, and the lesion could be observed by incision. The lesion was adhered to the peripheral tissue and was grayish-white and tough with a poor blood supply and a diameter of approximately 0.8 cm. The lesion was resected completely. The results of pathological examination by both hematoxylin-eosin staining and acid-fast bacilli staining confirmed TB, accompanied by acute and chronic suppurative inflammation and granulation tissue formation. The patient was instructed to continue anti-TB treatment after the operation, but he did not follow the medical advice. Follow-up continued for ten years, the patient had persistent paraplegia, the numbness disappeared and urine/fecal sensation recovered.
Although TB is a kind of benign disease, some cases progress rapidly. Moreover, spinal intramedullary TB may seriously endanger quality of life and still needs timely diagnosis and proper treatment.
Core Tip: Tuberculosis mostly attacks the lungs, and extrapulmonary tuberculosis involving the central nervous system is rare. However, we should still pay attention to these cases in order to timely diagnose and properly treat. We report a case of a young male patient diagnosed with tuberculous meningitis. His disease progressed and involved the spinal cord, leading to paraplegia and urine/fecal incontinence. Unfortunately, after surgical resection of the spinal intramedullary lesion, the paraplegia failed to recover, and only urine/fecal sensation recovered. As a result, the patient remained in a wheelchair for ten years after the operation.