gms | German Medical Science

Objective: In 2014 a young female patient with migrant background showed an acute paresis of the legs so that walking was not possible anymore. The MRI showed an intramedullary contrast enhancing lesion at the level of 10^th/11^th thoracic vertebral body. Because of clinical manifestation and to get histological results we decided to remove the lesion surgically. During surgery total removal of the lesion was possible. The preoperative suspicion of a spinal manifestation of tuberculosis could be confirmed.

Methods: The primary method was the operation for removing the lesion. For assuring the diagnosis an intraoperative microscopic analysis with a specific stain (Ziehl Neelsen) was done. Postoperative we initiated a Quantiferone test.

Results: Tuberculosis was validated by detection of Mycobacterium tuberculosis (acid-resistant) during surgery and later on by Tbc-skin test and an analysis of sputum. Under calculated antibiotic therapy clinical symptoms got better, the paraplegia regressed slowly. At the last outpatient treatment there was residual pain in the left leg accompanied by a mild hypoesthesia. The paraparesis was improved profoundly. She was able to walk with crutches because of a spinal ataxia and is expecting a baby. The antibiotic treatment was stopped after 12 months.

Conclusion: This case shows the high relevance of tuberculosis as differential diagnosis becoming more and more important, especially under the aspect of the many refugees arriving in European countries at this time. If people who have an intraspinal or intracerebral lesion show other symptoms like cough, fever and malaise and if they maybe have a migrant background it is important to consider such a rare differential diagnosis like Tbc.