Extramedullary Haematopoiesis Presenting with Backache and Paraparesis - A Case Report

Author(s): Dhruba Borpatragohain1, Jahangir Kabir Laskar2, Arnav Kashyap3, Boby Das4

A 49-year-old female patient was admitted in the medicine department of Assam
Medical College with complaints of paraparesis of 15 days duration and backache
of 3 months’ duration. She had history of dizziness and low blood pressure. On
general examination, she had tachycardia (heart rate of 126 beats / min),
tachypnoea (respiratory rate 24 / min), severe pallor and bilateral non-pitting
pedal oedema. The patient had low haemoglobin (6.6 gm / dl) with red blood cell
(RBC) count of 2.5 million / mm3.
She was sent to the radio-diagnosis department for non-contrast computed
tomography (CT) scan of thorax and contrast enhanced magnetic resonance
(CEMR) of dorsolumbar region. On CT scan, soft tissue density lesions were noted
in paraspinal region extending from lower thoracic, lumbar region without
destruction of vertebral bodies. Additional findings include hepato-splenomegaly
and left sided pleural effusion. On CEMR, there was T1 hypo and T2 / T2FSisointense
soft tissue lesion in paraspinal region extending from lower thoracic,
lumbar and sacral vertebrae. The lesions were showing diffusion restriction,
diffusion weighted imaging (DWI) with low apparent diffusion coefficient (ADC)
value and mild enhancement on post contrast scan. The soft tissue component
was noted to extend into the epidural space in multiple vertebral levels in thoracic,
lumbar and sacral regions causing spinal canal stenosis, maximum (7.0 mm) at L4
vertebral level. Based on the imaging findings, a diagnosis of extramedullary
haematopoiesis in paraspinal region with extension of the soft tissue in the
epidural space leading to compression of spinal cord at multiple levels was made.