Tubercular arachnoiditis: A rare culprit of paraparesis in a young adult - A case report and review of literature.

Background: The prevalence of central nervous system tuberculosis (TB) is about 1-2% of all TB cases. Atypical cases like the present case, being interpreted as leptomeningeal metastasis in magnetic resonance imaging (MRI), can pose a dilemma, delaying or even leading to mistreatment.

Case description: A 19-year-old male presented with acute onset paraparesis and bowel bladder involvement presented with an MRI lumbar spine suggesting leptomeningeal metastasis from D11-L5 levels who underwent decompression biopsy which on histopathological examination revealed to be tubercular granulomatous infection. Anti-tubercular drug (ATD) started, and significant improvement was seen in the lower limb power and tone. The outcome of treatment has been unpredictable. Previous case studies having neurological deficits due to severe compression, including ours, show good recovery after surgical decompression and ATD regime.

Conclusion: Such cases should be managed with high suspicion as they can be easily misdiagnosed to be tumors, leading to mistreatment or delayed treatment.