A South Indian 23-year-old gravida 1 woman in her second trimester was admitted from the emergency department complaining of lower back pain and feeling constipated. She had had an abscess over the right eighth rib incised and drained 1 month previously. No initial imaging was performed. At 3 days later she developed complete paraplegia and an MRI scan showed a 9×8 mm tuberculoma on the medulla oblongata (fig 1). She was treated with antituberculous chemotherapy and a caesarean section planned. Her paraplegia has not yet fully resolved.

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Figure 1

Sagittal MRI section of the brainstem and upper spine with gadolinium enhancement showing a 9×8 mm tuberculoma on the left medulla oblongata gutter. There is also diffuse abnormal enhancement of the meninges.

Spinal tuberculosis in pregnancy1 is rare and a high lesion on the medulla is even more uncommon. The classical site for spinal tuberculosis is the thoracolumbar junction and lesions may be multiple. One does not need a definite history of pulmonary tuberculosis to experience spinal disease. Diagnosis, especially in pregnancy, is difficult clinically and we urge clinicians to image early especially in those from areas in which tuberculosis is endemic.