A Rare Case of Concurrent Intramedullary and Brain Tuberculoma: Diagnostic Challenges and Management

Intramedullary spinal tuberculomas constitute a small percentage of spinal tuberculosis. These, in combination with brain tuberculomas, are an uncommon manifestation of central nervous system (CNS) tuberculosis. This report details a unique case of a 32-year-old retroviral disease-positive male who presented with a two-month history of symmetrical quadriparesis and recent seizures. The neurological assessment revealed significant weakness, with a power of 3/5, associated with stiffness, hypoesthesia below the neck, and urinary hesitancy. He was diagnosed via magnetic resonance imaging (MRI), which showed a characteristic target sign at the C2 level and a hyperintense lesion in the left high parietal lobe. In a multi-faceted approach, the patient received a 12-month regimen of five-drug anti-tubercular therapy, supplemented with physiotherapy and continuous antiretroviral treatment. This case highlights the crucial need to consider tuberculoma as a differential diagnosis in patients presenting with similar symptoms, while also keeping conditions such as toxoplasmosis, CNS lymphoma, and glioblastoma in mind. Early detection and intervention are vital, as prompt treatment can significantly change the trajectory of this debilitating disease, potentially saving lives and restoring neurological function.