The patient is a known hypertensive with recently recognized diabetes mellitus.

On examination: The patient is wheel chaired and cannot stand for Romberg or scoliotic stance assessment. The abdominal reflexes were absent both sides with SLRS 20 degrees in the right due to weakness and the left 60 degrees. Sensation was intact, but the patient claim numbness both lower limbs. There is gross weak all muscles both lower limbs more pronounced in the right side including the quadriceps muscles.

MRI of the dorsal spine was requested and a huge extramedullary mass was compressing the spinal cord at the D6-7 levels. It was reported to be a meningioma.
There was a discussion with relatives that the histological verification is hard to tell even during the surgery, and they were told that tbc could have place and the final result will be after the surgery.
Laminectomy of D6 and 7 was performed. The epidural fat was granulomatous and thick with loculations, some of them containing pus. The pus was sent for CXS and the mass was resected completely. It was adherent to the dura, but it was separable. Inspection of the dura for a mass intradural was negative. This was done by finger palpation. The dura was not opened intentionally to avoid dissemination of the pathologic material intradurally.

Routine closure of the wound with smooth postoperative recovery.

The blood sent for tbc IgG which was very high confirming that the lesion was tuberculous granulomatous epiduritis.

This is another example of tbc of the spine, which could mimic any pathologic process.

In 08-March-2007 there was an announcement that tbc of the spine is gaining a new clinical picture and is increasing in frequency.