Published: 2019-02-22

Recurrent ominous spinal mass

Maria Gollwitzer, Wolfgang Hasenauer, Anja Grimmer, Andreas Gruber


Hypertrophic pachymeningitis is a very rare form of diffuse inflammatory dural fibrosis. It is typically encountered intracranially rather than spinally and can have a progressive and recurrent course as encountered in our patient. The aetiology of this disorder is multifactorial. While acute management of hypertrophic pachymeningitis consists of immediate decompression in conjunction with steroid medication and treatment of the underlying disease, the management of chronic and recurrent disease is controversially debated in the current literature. A previously healthy 49-year-old woman presented with progressive back pain and acute onset of incomplete paraplegia. Spinal MRI showed a large ventral semicircular mass with intense contrast enhancement from Th3-8. Acute patient management consisted of immediate decompression and debulking the space-occupying lesion in conjunction with antibiotic and steroid therapy. Histopathologic examination of the surgical specimens revealed a chronic inflammatory process. The patient fortunately recovered from the severe paraparesis and upon discharged, spinal MRI disclosed a further regressing residual spinal mass. Over time, our patient suffered two times a relapse and was finally treated with Methotrexate and low-dose steroids. Under this medication she has made a nearly complete neurological recovery. This case report highlights a rare disease with challenging management, which should be considered diagnostically in patients with intraspinal space-occupying lesions. In our experience combination of Methotrexate and low-dose steroids might be an effective and safe treatment.


Idiopathic meningitis, Pachymeningitis, Spine, Treatment

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