Cutaneous tuberculosis on the scalp: a case report

Tuberculosis is a disease that usually affects the lungs, although other systems may also be infected, resulting in atypical clinical presentations. We report the case of a 76-year-old man who was admitted to the hospital in Brazil with a 3-week history of a painful, enlarging ulcer on the scalp and cough. His medical history was notable for non-metastatic prostatic adenocarcinoma and esophageal squamous cell carcinoma. On physical examination, the ulcer measured 10 cm in diameter and was tender, with a firm border and yellow crusts. A punch-biopsy specimen of the edge of the ulcer showed acute and chronic non-specific inflammation and neutrophilic infiltrates. Acid-fast bacilli were seen on microscopic examination, molecular testing detected Mycobacterium tuberculosis DNA and pan-sensitive M. tuberculosis was cultured. Computed tomography (CT) scan of the head showed a frontoparietal osteolytic lesion under the ulcer, chest CT revealed areas of consolidation in the lower lobes and M. tuberculosis was also identified in a bronchoalveolar lavage specimen. After one month of combination therapy with rifampin, isoniazid, pyrazinamide and ethambutol his symptoms were found to be improving and the size of the ulcer was markedly reduced.