Tuberculoma of the conus medullaris

A 52 year old female presented with a one month history of progressive back pain radiating to the right lower limb. She reported unintentional weight loss of seven kilograms over three months and drenching night sweats. There was no history of cough. Her physical examination was unremarkable. A HIV ELISA test was positive. Her CD4 count was 27 cells/mm³ and viral load was 1.8 million copies/ml. An MRI spine (A,B) to evaluate the back pain revealed a single spinal ring enhancing lesion at T12 with minimal perilesional edema. A chest CT scan was in keeping with miliary tuberculosis. Sputum TB GeneXpert was positive for Mycobacterium tuberculosis. Anti TB therapy was initiated with subsequent resolution of back pain. Back pain in a patient with miliary TB may indicate vertebral involvement or rarely, as in this case, intramedullary tuberculomas. Prognosis is usually good.