Medullary tuberculosis mimicking a multiple schwannoma
Background: Despite progress in the management of Tuberculosis (TB), it remains a major public health problem. Intramedullary tuberculosis is rare, and the rarity of this disease in the medullary cone makes preoperative diagnosis difficult. We report a case of intramedullary tuberculosis assimilated...
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Elsevier
2025-06-01
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| Series: | Interdisciplinary Neurosurgery |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751925000581 |
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| author | Mèhomè Wilfried Dossou Wilfried Innocent Munkado Meuga Ibrahim Issa Assoumane Kpègnon Nicaise Agada Laté Dzidoula Lawson Konan Médard Kakou |
| author_facet | Mèhomè Wilfried Dossou Wilfried Innocent Munkado Meuga Ibrahim Issa Assoumane Kpègnon Nicaise Agada Laté Dzidoula Lawson Konan Médard Kakou |
| author_sort | Mèhomè Wilfried Dossou |
| collection | DOAJ |
| description | Background: Despite progress in the management of Tuberculosis (TB), it remains a major public health problem. Intramedullary tuberculosis is rare, and the rarity of this disease in the medullary cone makes preoperative diagnosis difficult. We report a case of intramedullary tuberculosis assimilated to a multiple schwannoma. Case presentation: A 14-year-old patient presented with a 7-month history of decreased hearing associated with micturition problems ranging from overflow voiding to acute urine retention 2 weeks ago. Clinical examination revealed right-sided hypoacusis and terminal cone syndrome. On paraclinical examination, audiometry showed conductive hearing loss on the right and a slight transmission loss on the left. A CT scan of the hip did not reveal any abnormality in the urinary tract. Thoracolumbar MRI showed a diffuse intramedullary lesion extending between T11 and L1, suggesting a low-grade glial lesion, particularly an astrocytoma or ependymoma. Given the auditory symptoms, the hypothesis of a multiple neuroma with cerebral and intramedullary localization was raised and a cerebral CT scan performed for this purpose came back normal. Tumour resection revealed a heterogeneous whitish process with a fleshy and soft necrotic portion. The pathological examination concluded that the tumor was tuberculous. The PCR came back negative and the patient was put on anti-tuberculosis treatment and corticosteroid therapy for 30 days. Progression was favorable, with progressive motor recovery from day 6 and complete recovery at day 60. Hearing loss persisted and was managed by ENT specialists. Conclusion: Intramedullary tuberculosis remains a reality. The insidious clinical picture and the atypical imaging appearance are factors in misdiagnosis. An effective meta-analysis would be timely to clarify the diagnostic presentation and allow agreement on the role of surgery in the face of chemotherapeutic measures. |
| format | Article |
| id | doaj-art-e7fc8068ae664c76b5d736c5cf6ef588 |
| institution | DOAJ |
| issn | 2214-7519 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj-art-e7fc8068ae664c76b5d736c5cf6ef5882025-08-20T03:05:42ZengElsevierInterdisciplinary Neurosurgery2214-75192025-06-014010204610.1016/j.inat.2025.102046Medullary tuberculosis mimicking a multiple schwannomaMèhomè Wilfried Dossou0Wilfried Innocent Munkado Meuga1Ibrahim Issa Assoumane2Kpègnon Nicaise Agada3Laté Dzidoula Lawson4Konan Médard Kakou5Abdou Moumouni University of Niamey, Department of Neurosurgery, National Hospital of Niamey, Niger; Research Department of Sub-Saharan Africa Futures Neurosurgeons Association (SAFNA), Cotonou, Benin; Neurosurgery Department, Felix Houphouët Boigny University of Abidjan, Cote d'Ivoire; Corresponding author at: Abdou Moumouni University of Niamey, Department of Neurosurgery, National Hospital of Niamey, Niger .Neurosurgery Department, Felix Houphouët Boigny University of Abidjan, Cote d'IvoireAbdou Moumouni University of Niamey, Department of Neurosurgery, National Hospital of Niamey, NigerAbdou Moumouni University of Niamey, Department of Neurosurgery, National Hospital of Niamey, Niger; Research Department of Sub-Saharan Africa Futures Neurosurgeons Association (SAFNA), Cotonou, BeninAbdou Moumouni University of Niamey, Department of Neurosurgery, National Hospital of Niamey, Niger; Research Department of Sub-Saharan Africa Futures Neurosurgeons Association (SAFNA), Cotonou, Benin; Neurosurgery Department, Felix Houphouët Boigny University of Abidjan, Cote d'IvoireNeurosurgery Department, Felix Houphouët Boigny University of Abidjan, Cote d'IvoireBackground: Despite progress in the management of Tuberculosis (TB), it remains a major public health problem. Intramedullary tuberculosis is rare, and the rarity of this disease in the medullary cone makes preoperative diagnosis difficult. We report a case of intramedullary tuberculosis assimilated to a multiple schwannoma. Case presentation: A 14-year-old patient presented with a 7-month history of decreased hearing associated with micturition problems ranging from overflow voiding to acute urine retention 2 weeks ago. Clinical examination revealed right-sided hypoacusis and terminal cone syndrome. On paraclinical examination, audiometry showed conductive hearing loss on the right and a slight transmission loss on the left. A CT scan of the hip did not reveal any abnormality in the urinary tract. Thoracolumbar MRI showed a diffuse intramedullary lesion extending between T11 and L1, suggesting a low-grade glial lesion, particularly an astrocytoma or ependymoma. Given the auditory symptoms, the hypothesis of a multiple neuroma with cerebral and intramedullary localization was raised and a cerebral CT scan performed for this purpose came back normal. Tumour resection revealed a heterogeneous whitish process with a fleshy and soft necrotic portion. The pathological examination concluded that the tumor was tuberculous. The PCR came back negative and the patient was put on anti-tuberculosis treatment and corticosteroid therapy for 30 days. Progression was favorable, with progressive motor recovery from day 6 and complete recovery at day 60. Hearing loss persisted and was managed by ENT specialists. Conclusion: Intramedullary tuberculosis remains a reality. The insidious clinical picture and the atypical imaging appearance are factors in misdiagnosis. An effective meta-analysis would be timely to clarify the diagnostic presentation and allow agreement on the role of surgery in the face of chemotherapeutic measures.http://www.sciencedirect.com/science/article/pii/S2214751925000581TuberculosisMimickingMultiple schwannoma |
| spellingShingle | Mèhomè Wilfried Dossou Wilfried Innocent Munkado Meuga Ibrahim Issa Assoumane Kpègnon Nicaise Agada Laté Dzidoula Lawson Konan Médard Kakou Medullary tuberculosis mimicking a multiple schwannoma Interdisciplinary Neurosurgery Tuberculosis Mimicking Multiple schwannoma |
| title | Medullary tuberculosis mimicking a multiple schwannoma |
| title_full | Medullary tuberculosis mimicking a multiple schwannoma |
| title_fullStr | Medullary tuberculosis mimicking a multiple schwannoma |
| title_full_unstemmed | Medullary tuberculosis mimicking a multiple schwannoma |
| title_short | Medullary tuberculosis mimicking a multiple schwannoma |
| title_sort | medullary tuberculosis mimicking a multiple schwannoma |
| topic | Tuberculosis Mimicking Multiple schwannoma |
| url | http://www.sciencedirect.com/science/article/pii/S2214751925000581 |
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