Conus Medullaris Tuberculoma

A Case Presentation

Abstract

Background: Intramedullary tuberculoma of the conus medullaris is an extremely rare and significant tumor mimic with limited representation in the literature. We present a case of intramedullary conus medullaris tuberculoma with clinical diagnosis and therapeutic management. Case Presentation: A 44-year-old male with a 3-month history of unintentional weight loss, drenching night sweats, chronic cough and an associated bilateral lower limb weakness with difficulty walking. Physical examination and diagnostic tests, including a complete blood count, erythrocyte sedimentation rate, a triple serology, chest xray and an MRI revealed a lower limb power grade 3 with hypotonia and normoreflexia, mild monocytosis, elevated ESR, negative serology, miliary opacification, and a conus intramedullary ring-enhancing lesion. Based on the presentation, clinical suspicion and imaging features, a clinical diagnosis of intramedullary tuberculoma was made and the patient was initiated on the initiation phase of anti-tuberculous medication plus dexamethasone. He is currently ambulant and has regained full function of both lower limbs. Discussion: This case underscores the importance of history and clinical suspicion in the diagnosis and management of infective spinal disease to avert invasive management. The presence of miliary TB and neurological involvement underscores the importance of integrating radiological findings with clinical judgment to establish an early diagnosis. It contributes to the limited body of literature on Conus medullaris tuberculoma. Conclusion: Intramedullary tuberculoma, though rare, should be considered in patients presenting with neurological deficits and systemic symptoms of tuberculosis. This case report demonstrates the relevance of secondary pulmonary tuberculosis and suggests a collection of more cases for literature and clinical application.