CASE REPORTS

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

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.