ABSTRACT
Introduction: Spinal cord compression is a common problem in clinical practice. Sometimes puzzling symptoms may mislead the clinician in the initial days. Case details: We present a 59 year old lady who presented with progressive numbness of both feet and abdomen, walking difficulties for which the initial evaluation did not yield any result. The work up at our facility showed collapsed D3 vertebra, prevertebral collection and cord compression. She was tentatively started on antituberculous treatment, based on the radiologist opinion. Two months later, the patient had further progression of symptoms and had to undergo D3 laminectomy and surgical decompression. She also developed hypertension and diabetes in the meantime. Histopathology did not favour tuberculous process, but showed amyloid deposition. Antituberculous treatment was halted and she was evaluated for plasma cell dyscrasias. The serum protein electrophoresis with immunofixation was in favour of IgG Kappa light chain monoclonal gammopathy. She was further subjected to bone marrow aspiration and biopsy at a Cancer institute. The result was negative for plasma cell malignancy, and was suggestive of only reactive lymphocytosis. On the advice of oncologist, antituberculous treatment was started again and continued as RH- two drug regimen for 9 months along with supportive care. She improved symptomatically, able to walk independently and attended regular follow up. Three years later, a repeat MRI scan showed enlargement of the lesion to involve the posterior mediastinum. The oncology service decided to irradiate the lesion, only if she develops new symptoms. Conclusion: This outcome suggests the unusual presentation of the disease, and the so litary amyloidoma is probably a primary disease in itself or secondary to a neoplastic process.