INTRODUCTION:Tuberculosis remains a significant global health burden, with central nervous system (CNS) involvement being a rare but serious manifestation. While pulmonary tuberculosis is the most common form, extrapulmonary manifestations can affect various organs and systems. The CNS involvement in developing countries constitutes nearly 10% of all tuberculosis patients [1]. Tuberculomas with compressive myelopathies without bone involvement are an even rarer occurrence. In the differential diagnosis of extensive spinal cord injuries, particularly in young patients with a history of pulmonary tuberculosis or tuberculous meningitis, it is important to consider the possibility of an intradural extramedullary tuberculoma [2].Here we will be discussing a case of intradural extramedullary tuberculosis of the thoracic spine, with progressive neurological dysfunction. Surgery aims to decompress the spinal cord and remove the tuberculoma, thereby relieving the pressure on the neural tissues and preventing further neurological deterioration [3-5]. The specific surgical technique employed depends on the location and extent of the tuberculoma.Following surgery, anti-tubercular therapy is initiated to target the underlying tuberculosis infection. This typically involves a combination of multiple anti-tuberculosis medications, such as isoniazid, rifampicin, ethambutol, and pyrazinamide [2]. The duration of anti-tubercular therapy may vary but generally lasts several months to ensure complete eradication of the infection. Continual postoperative monitoring assumes paramount importance in assessing neurological recovery and treatment response. Concurrently, physiotherapy and rehabilitation assume significance in facilitating the functional restoration and enhancing the overall quality of life [1].This report aims to discuss the diagnostic challenges, treatment strategy, and clinical outcomes, highlighting the importance of a multidisciplinary approach in managing this uncommon condition.

INTRODUCTION:Tuberculosis (TB) is still one of the most prevalent infections, especially in the developing world. The World Health Organisation (WHO) estimates that there are 8 million new cases annually [1,2]. Cough, sputum with or without haemoptysis, fever, and constitutional symptoms are the hallmark manifestations of an active tuberculosis infection. In patients with pulmonary TB, an increase in haemoglobin levels is regarded as an indicator of a positive response to treatment. Furthermore, Omar et al. found that a fall in platelet count, white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR) were strong indications of clinical response [3]. Despite the possibility of an increase in white blood cells (WBC), which results in lymphocyte predominance, in clinical practice, eosinophilia is a usual finding that is self-limiting in moderate cases, but it is exceedingly infrequent in TB [4,5].Many allergic, viral, and neoplastic conditions may produce peripheral blood eosinophilia, necessitating a variety of examinations and subsequent therapy. Common causes of eosinophilia in children include infections with helminthic parasites, allergic diseases, malignancies, and adverse drug reactions [1,6]. One of the primary goals of the early evaluation is to identify an underlying cause that needs specific therapy. Even though difficulties linked with eosinophilia are more prevalent in individuals with higher eosinophil counts (>1500 eosinophils/uL), the peripheral blood eosinophil count does not accurately assess the risk of organ damage in each patient. A patient with modest peripheral blood eosinophilia may also have significant eosinophil organ involvement. Normal eosinophil counts in the human blood range between 0-350/mm3. This quantity accounts for between 1 and 3% of the differential leukocyte count [7]. Most reports of eosinophilia in tuberculosis describe local eosinophilia as opposed to peripheral eosinophilia [8]. To the best of our knowledge, reported cases are very rare. As a consequence, we describe one case of TB with considerable peripheral eosinophilia and the treatment outcome.

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Trauma or surgery to the lower limbs can cause fat from the marrow within the leg bones to enter the bloodstream and form an embolus. However, if there is cerebral involvement without any pulmonary or dermatological manifestations at diagnosis, it could delay identifying cerebral fat embolism (CFE).