Ectopic ossification in tuberculous meningitis

Abstract

Ectopic ossification was demonstrated radiologically in five of 10 children who developed temporary paraplegia in flexion during streptomycin treatment of tuberculous meningitis and survived for more than three months. It was found two to six months after the onset of the paraplegia. In all cases the ossification affected the iliopsoas or the adductors of the thighs and their tendons below the level of the pelvis. The lesions were bilateral in three patients. They led to severe disability in two children by fixing the hip joints and to less severe symptoms in the others. Operative removal of the new bone in one child led to more extensive deposition of new bone and a worsening of his condition. In two conservatively treated patients there was subsequent radiological evidence of spontaneous absorption of new bone after recovery from meningitis. The diagnosis was established radiologically in all patients and was confirmed at operation in one and at necropsy in another child. Histologically the ectopic tissue appeared to be normal bone with bone marrow. The incidence and nature of neurogenic metastatic ossifications was reviewed. No previous instances in association with tuberculous meningitis have been found.