Intramedullary Spinal Tuberculosis Mimicking Neoplasm with Ocular Involvement in an Adolescent: A Case Report An Unusual Presentation of Pediatric CNS Tuberculosis
Iranian Journal of Child Neurology,
Vol. 20 No. 4 (2026),
1 September 2026
,
Page e9
https://doi.org/10.22037/ijcn.v20i4.50437
Abstract
Tuberculosis (TB) remains a major health challenge in high-burden countries, with children particularly vulnerable to severe extrapulmonary disease. Intramedullary spinal TB is exceptionally rare and may mimic neoplasms, often resulting in delayed diagnosis and poor outcomes. This study aims to report a complex pediatric case of multisystem TB with intramedullary spinal involvement initially misdiagnosed as a neoplasm and to highlight the devastating consequences of delayed recognition. A 16-year-old boy from a low socioeconomic background presented with progressive bilateral lower-limb weakness, visual impairment, and systemic features. MRI demonstrated an intramedullary mass at T5–T6 with syringomyelia, para-aortic lymphadenopathy, and hepatosplenomegaly, initially suspected to be a spinal tumor. During hospitalization, he developed hydrocephalus, seizures, and respiratory failure. He underwent ventriculoperitoneal shunting and excision of the spinal lesion. Histopathology confirmed intramedullary spinal TB. Despite maximal supportive management, he deteriorated and ultimately progressed to brainstem death due to multisystem complications. This case emphasizes the need to consider TB in the differential diagnosis of spinal cord masses in children from endemic regions, particularly when ocular or systemic involvement is present. Early recognition and prompt initiation of anti-tuberculosis therapy are essential to prevent irreversible morbidity and mortality.
- Tuberculosis, Spinal
- Tuberculosis, Central Nervous System
- Tuberculosis, Extrapulmonary
- child
- Diagnosis, Delayed
How to Cite
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