Coexisting Spinal Intramedullary and Intracranial Tuberculomas in an Immunocompetent Child

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Pediatric neurotuberculosis commonly involves tuberculous meningitis and intracranial tuberculomas.
• Intramedullary tuberculomas (IMTs) are rare spinal cord lesions.
• The coexistence of IMT and intracranial tuberculoma is exceptionally uncommon.

Observation:

• A 5-year-old boy presented with fever, progressive lower limb weakness, urinary retention, and constipation.
• Neurological examination indicated compressive myelopathy.
• Spinal MRI revealed an intramedullary tuberculoma at D4-D5 with edema; brain MRI showed a right frontal tuberculoma.

Findings:

• The case highlights an extremely rare instance of coexisting intramedullary and intracranial tuberculoma in a child.
• Magnetic resonance imaging was crucial for diagnosing both spinal and intracranial lesions.
• Successful management involved a combination of antituberculosis therapy and corticosteroids.

Implications:

• This case underscores the importance of considering disseminated neurotuberculosis even in rare presentations.
• Prompt diagnosis and multimodal treatment can lead to favorable neurological outcomes in pediatric patients.
• Further research into the pathogenesis and optimal management of coexisting spinal and intracranial tuberculomas is warranted.