Intramedullary Spinal Tuberculosis Mimicking Neoplasm with Ocular Involvement in an Adolescent: A Case Report

Tuberculosis (TB) continues to represent one of the key health problems of high-burden nations. The childhood population is particularly vulnerable to extrapulmonary TB. Spinal intramedullary TB is extremely uncommon and can imitate neoplastic conditions, leading to a late diagnosis with fatal outcome. The current research intends to present a complex case of multisystem TB with intramedullary spinal infection that was incorrectly diagnosed and treated as a neoplasm in a pediatric patient and demonstrate the negative consequences of such misinterpretation. The authors report on a 16-year-old patient who had a low socioeconomic status and suffered from progressive bilateral lower-extremity paresis, vision problems, and multisystemic involvement. MRI demonstrated an intramedullary mass at T5-T6 with syringomyelia, para-aortic lymphadenopathy, and hepatosplenomegaly, initially suspected to be a spinal tumor. During hospitalization, he developed hydrocephalus, seizures, and respiratory failure. He underwent ventriculoperitoneal shunting and excision of the spinal lesion. Histopathology confirmed intramedullary spinal TB. Despite maximal supportive management, he deteriorated and ultimately progressed to brainstem death due to multisystem complications. This case emphasizes the need to consider TB in the differential diagnosis of spinal cord masses in children from endemic regions, particularly when ocular or systemic involvement is present. Early recognition and prompt initiation of anti-TB therapy are essential to prevent irreversible morbidity and mortality.