Primary CALVARIAL tuberculosis: A case report

Calvarial tuberculosis is a rare manifestation of extra pulmonary tuberculosis. Primary calvarial tuberculosis, with no evidence of tuberculosis elsewhere in the body, is an even rarer entity. Most cases are often misdiagnosed as osteomyelitis, syphilis, or bony metastasis among others.

We report a case of primary calvarial tuberculosis in a 17 years old female with complaints of progressively increasing swelling over the right frontoparietal region and headache with no history of previous tuberculosis. The patient was operated, and histopathological examination of excised tissue was suggestive of tubercular pathology. The patient is doing well after surgery and anti-tubercular therapy.

Skeletal tuberculosis occurs in approximately 1 % of cases of mycobacterial infection, and calvarial tuberculosis accounts for 0.2 % to 1.3 % of all cases of skeletal tuberculosis. Early clinical signs are usually absent. The emergence of a painless, fluctuant swelling stands out as the most common presentation. Radiological findings, which are very valuable tools to reach a diagnosis, are known to be variable and nonspecific. The gold standard for diagnosis is the demonstration of Acid Fast Bacilli (AFB) on microscopy and growth on culture. Treatment includes surgery and antituberculous therapy.

Primary calvarial tuberculosis is a rare entity that can present with diverse symptoms and mimic other pathologies. A high index of suspicion should be maintained, especially in endemic areas, to ensure timely and accurate diagnosis. Surgery and antituberculous therapy remain the treatment of choice. Follow up is crucial to monitor for recurrence and other associated complications.