A rare case of calvarial tuberculosis

Calvarial tuberculosis (TB) is a rare entity forming 0.2%–1.3% of skeletal TB. The authors report a case of 45-year-old male presented with a history of fall under the influence of alcohol. Two cut lacerated wounds were noted in the right frontotemporal region. Computed tomography (CT) showed right frontal hematoma with brain edema. The patient underwent right frontal craniotomy and evacuation of the hematoma. Scalp wounds were healed. After 3 months, the patient presented with a pus discharging sinus from one of the previous cut lacerated wound. No growth was found in the pus culture. It was treated with dressing and antibiotics. Due to the persistence of the pus, CT scan was taken after 7 months, which showed osteomyelitis of right frontal bone. Right frontal osteomyelitic bone, along with overlying subgaleal tissue, was excised. Histopathological examination of the bone showed focal inflammatory cell infiltration. Overlying tissue on hematoxylin and eosin stain showed caseating epithelioid cell granuloma surrounded by lymphocytes and Langhans multinucleate giant cell suggestive of TB. The patient recovered after 1 year of treatment with antitubercular treatment. In country like India, TB can present in any atypical locations. Persistent pus discharge from the scalp following surgery or trauma should raise the suspicion of TB. Persistent pus discharge not responding to conventional therapy should be investigated for TB. All the excised osteomyelitic skull bone should be sent for histopathological examination.