Intramedullary tuberculoma mimicking primary CNS lymphoma

Department of Neurological Surgery, University of Washington School of Medicine, Seattle, USA.
Journal of Neurology Neurosurgery & Psychiatry (Impact Factor: 6.81). 12/2004; 75(11):1636-8. DOI: 10.1136/jnnp.2003.029926
Source: PubMed


The incidence of primary central nervous system lymphoma (PCNSL) has been on the rise in the setting of immunodeficiency syndromes such as acquired immune deficiency syndrome (AIDS). Its diagnosis has been facilitated by the advent of a cerebrospinal fluid (CSF) Epstein-Barr virus (EBV) PCR assay. The reported high sensitivity and specificity of this assay has made it the cornerstone of diagnosis of PCNSL, replacing more traditional methods such as an open CNS biopsy. Here, we have described a patient with a known history of C3 AIDS presenting with lower extremity weakness and eventual myelopathy who was later diagnosed as having intramedullary PCNSL after detection of EBV DNA in his CSF. After failing to respond to radiotherapy, he underwent a spinal cord biopsy revealing intramedullary tuberculoma. This case illustrates the risk of misdiagnosis with this assay and the importance of histological confirmation of a pathological lesion prior to implementation of therapy.

Download full-text


Available from: Robert Rostomily, Jan 29, 2015

  • 7th Annual Congress of Association of Medical Microbiologists,; 01/1983
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Tuberculosis and other mycobacterial diseases are frequent coinfections in AIDS patients with an increased related mortality. In this review we have updated the treatment of the main mycobacterial diseases (tuberculosis and Mycobacterium avium disease), under the scope of pharmacological interactions between antimycobacterial drugs, specially rifampicin and clarithromycin, and anti-retroviral drugs. Antimycobacterial treatment schemes, their duration, primary and secondary chemoprophylaxis and the optimal time to start the anti-retroviral therapy are analized. Finally, the immnune reconstitution inflammatory syndrome and its treatment are discussed.
    Medicina 02/2005; 65(4):353-60. · 0.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Intramedullary spinal tuberculomas are a rare cause clinical entity of spinal cord compression. Eight intramedullary tuberculomas including the present case have been described recently located thoracic region. We report a case who had an intramedullary spinal cord tuberculoma in which the diagnosis was made histologically, without evidence of symptoms of systemic tuberculosis. This lesion, located thoracic intramedullary tuberculoma, mimicked an intramedullary tumor as radiologically. A patient was 72-year-old woman who presented with a history of progressive paraparesia. First diagnosis was made as intramedullary tumor by MRI. The significance and the use of magnetic resonance imaging (MRI) in the diagnosis of intramedullary tuberculoma, and the treatment of the patient that involves surgically the excision of intramedullary lesion followed by appropriate antituberculous therapy. This case is the oldest among the ones who have been published operated cases since 1960. Postoperatively, her neurological symptoms were parsially improved. With combination of both medical and surgical treatments, excellent clinical outcome was obtained after two years. In conclusion, this case illustrates the risk of misdiagnosis with this assay and the importance of histological confirmation of a pathological lesion prior to surgical therapy, it should be kept in mind the differential diagnosis of the intrameduller spinal dord tumors.
Show more