Pseudotumoral Tuberculous Myelitis. Case Report

Background: Tuberculous myelitis and its pseudotumoral form is considered an exceptional entity characterized by clinical and radiological polymorphism. The differential diagnosis concerns tumor cases. Hence, we report an isolated cervical pseudotumoral myelitis tuberculosis case, and we discuss the pathophysiological, clinical, imaging features and therapeutical option. Case presentation: A 45-year-old woman developed a progressive tetraparesis, sensory disturbances and bladder dysfunction. Spinal MRI showed hyperintensT-2-weighted sections, with contrast enhancement of a a well-circumscribed lesion of the posterior horn, extending from C3–C7 (Fig. 1). The diagnosis of an astrocytoma was suggested. The patient underwent surgery with partial resection. Histopathological analysis confirms the diagnosis of tuberculous myelitis. In addition the blood GeneXpert MTB was positive. The patient received high-dose steroid therapy(500 mg of methylprednisolone intravenously per day for five continuous days. At the same time, she received anti-tuberculosis therapy and physiotherapy. The patient showed slow recovery. Conclusion: Tuberculous myelitis diagnosis is difficult in its isolated and pseudotumoral form even with IMR. Surgical biopsy, in absence or negativity of biological markers, is an ultimate option to confirm the diagnosis. Anti-tuberculosis drug treatment associated to high dose of corticosteroids and early diagnosis lead to a good outcome.