Intramedullary neurotuberculoma in a patient with disseminated tuberculosis: A case report and a narrative review

Tuberculosis has a wide spectrum of clinical manifestations. Intramedullary tuberculomas are a rare form of central nervous system tuberculosis, accounting for only 0.2%-0.5% of all CNS tuberculomas. We report the case of a 28-year-old man with a history of non-Hodgkin lymphoma treated in 2014 who developed areflexic paraparesis with pyramidal signs and fecal incontinence shortly after initiating RIPE therapy for disseminated extrapulmonary tuberculosis. An MRI showed a nodular, intramedullary lesion, T10-T11 measuring approximately 1.2 × 0.8 × 0.7 cm, with intermediate signal on T2 and isosignal on T1, with complete peripheral and annular gadolinium uptake. A narrative review was performed using the keywords "intramedullary," "spinal cord," and "tuberculoma" in October 2024 including 120 articles; 26 were selected for full reading, with 22 included. Based on the previous literature, 35 patients were included. The majority of cases were from low- and middle-income countries (n = 33). 62% of the patients were male (n = 22), 57% of the patients had involvement in the thoracic segment (n = 19); 24% in the cervical (n = 9); and 18% in the lumbar (n = 6). Regarding treatment, the duration of treatment with RIPE varied across different studies. Surgical treatment was performed in 54% of cases (n = 19), while 46% were managed conservatively (n = 16). Tuberculosis remains a significant cause of disability in low- and middle-income countries, as well as a major contributor to paraparesis. The treatment of these cases exhibits considerable heterogeneity, both in terms of the definition and the choice between conservative management and surgical intervention, as well as the duration of antituberculosis therapy.