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 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. [ABSTRACT FROM AUTHOR]