Tuberculous radiculomyelitis complicating tuberculous meningitis: Case report and review

Tuberculous radiculomyelitis (TBRM) is a complication of tuberculous mening itis (TBM), which has been reported rarely in the modern medical literature . We describe a case of TERM that developed in an human immunodeficiency vi rus (HIV)-infected patient, despite prompt antituberculous treatment. To ou r knowledge, this is the second case of TERM reported in an HIV-infected pa tient. We also review 74 previously reported cases of TERM. TERM develops a t various periods after TBM, even in adequately treated patients after ster ilization of the cerebrospinal fluid (CSF). The most common symptoms are su bacute paraparesis, radicular pain, bladder disturbance, and subsequent par alysis. CSF evaluation usually shows an active inflammatory response with a very high protein level. MRI and CT scan are critical for diagnosis, revea ling loculation and obliteration of the subarachnoid space along with linea r intradural enhancement. As in other forms of paradoxical reactions to ant ituberculous treatment, there is evidence that steroid treatment might have a beneficial effect.