title: Fulminant holocord intramedullary tubercular abscess with enigmatic presentation.
abstract: BACKGROUND
  Intramedullary and subarachnoidal tubercular abscesses are rare forms of spinal tuberculosis as compared with extradural collections secondary to vertebral tuberculosis.
  
  
  METHODS
  We herein present a 33-year-old, apparently healthy male patient who presented clinically as transverse myelitis, with a lesion at detected at conus cauda, developing fulminant holocord intramedullary tubercular abscess, treated with surgical evacuation and much later with anti-tubercular drugs. Atypical clinical, serological, imaging findings in addition to lack of knowledge of occurrence of fulminant intramedullary tuberculosis led to the delay in starting anti-tubercular treatment.
  
  
  CONCLUSIONS
  Early diagnosis requires a high index of suspicion, search for a primary focus of tubercular infection, investigation with magnetic resonance imaging (MRI) of spinal cord, biopsy, and confirmation with microscopy and culture, even in immunocompetent individuals. Early diagnosis, prompt treatment with surgical evacuation of abscess, and anti-tubercular drugs can lead to a good neurological recovery.
authors.affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Andhra Pradesh, India.
authors.forename: Kalyan
authors.initials: K
authors.lastname: Bommakanti
authors.forename: Rajesh
authors.initials: R
authors.lastname: Alugolu
authors.forename: Lakshmana Rao
authors.initials: LR
authors.lastname: Chittem
authors.forename: Madhusudan
authors.initials: M
authors.lastname: Patil
authors.forename: Anirrudh Kumar
authors.initials: AK
authors.lastname: Purohit
keywords: Filum terminale; intramedullary; spinal tuberculosis; subarachnoidal; tubercular abscess