Mycobacterial spindle cell pseudotumor of the spinal cord: Case report and literature review

We report the first description of spinal cord mycobacterial spindle cell pseudotumor. A patient with newly diagnosed advanced HIV presented with recent-onset bilateral leg weakness and was found to have a hypermetabolic spinal cord mass on structural and molecular imaging. Biopsy and cultures from...

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Bibliographic Details
Published in:Journal of neuroimmunology 2024-05, Vol.390, p.578329, Article 578329
Main Authors: Duong, Michael Tran, Ungemach, Adam, Malik, Faizan, Duong, Melissa T., Wasserman, Noah, Cooper, Kumarasen, Pantel, Austin R., O'Neil, Jessica C., Szep, Zsofia
Format: Article
Language:English
Subjects:
Adult
HIV
HIV Infections - complications
Humans
IRIS
Male
Mycobacteria
Mycobacterium avium-intracellulare Infection - diagnosis
Mycobacterium avium-intracellulare Infection - diagnostic imaging
Mycobacterium avium-intracellulare Infection - drug therapy
Spinal cord
Spinal Cord Diseases - diagnostic imaging
Spinal Cord Diseases - drug therapy
Spinal Cord Diseases - microbiology
Spindle cell pseudotumor
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Summary:We report the first description of spinal cord mycobacterial spindle cell pseudotumor. A patient with newly diagnosed advanced HIV presented with recent-onset bilateral leg weakness and was found to have a hypermetabolic spinal cord mass on structural and molecular imaging. Biopsy and cultures from blood and cerebrospinal fluid confirmed spindle cell pseudotumor due to Mycobacterium avium-intracellulare. Despite control of HIV and initial reduction in pseudotumor volume on antiretrovirals and antimycobacterials (azithromycin, ethambutol, rifampin/rifabutin), he ultimately experienced progressive leg weakness due to pseudotumor re-expansion. Here, we review literature and discuss multidisciplinary diagnosis, monitoring and management challenges, including immune reconstitution inflammatory syndrome. [Display omitted] •We report the first case of mycobacterial spindle cell pseudotumor of the spinal cord.•The patient was newly diagnosed with HIV when he developed progressive bilateral leg weakness.•Diagnosis was made by structural/metabolic imaging, cultures and biopsy.•Treatment with azithromycin, ethambutol, rifampin/rifabutin led to pseudotumor size reduction.•Pseudotumor rebound co-occurred with rising CD8 T cell count, suggesting role of immune reconstitution.
ISSN:0165-5728
1872-8421
1872-8421
DOI:10.1016/j.jneuroim.2024.578329