Occipital condyle syndrome: a rare manifestation of skull base tuberculosis

A man in his 30s from South Asia presented with progressive neck pain, occipital headache and right-sided tongue deviation (occipital condyle syndrome). Initial imaging identified a destructive skull base lesion involving the right clivus, occipital condyle and C1 vertebra with compression of the hypoglossal nerve, raising concerns for malignancy. Concurrent necrotic mediastinal lymphadenopathy prompted endobronchial ultrasound-guided biopsy, which confirmed necrotising granulomatous lymphadenitis with Mycobacterium tuberculosis complex DNA. Quadruple antituberculous therapy and adjunctive corticosteroids gave significant clinical and radiological improvement at 6 months. This case highlights the importance of considering tuberculosis in the differential diagnosis of destructive skull base lesions even in non-endemic regions and in patients with previously negative TB screening.