Intramedullary conus medullaris tuberculoma in an HIV-infected child: an unusual immune reconstitution inflammatory syndrome response

A human immunodeficiency virus-infected girl with previous cerebral tuberculosis presented with paraparesis and sphincter dysfunction after improvement in her CD4 count, following antiretroviral therapy. Magnetic resonance imaging of her spinal cord revealed a conus medullaris lesion, in keeping with a tuberculoma. Her neurological signs improved after initiating tuberculosis treatment and steroids. It is most likely that this case demonstrates an unusual central nervous system immune reconstitution inflammatory syndrome (IRIS) response and is probably the first reported case of conus medullaris tuberculoma IRIS in the literature.