# Primary CALVARIAL tuberculosis: A case report

## TL;DR

This paper presents a rare case of primary calvarial tuberculosis in a young female, emphasizing the challenges in diagnosis and treatment.

## Contribution

The paper contributes a documented case of primary calvarial tuberculosis, highlighting its rarity and diagnostic difficulties.

## Key findings

- Primary calvarial tuberculosis is rare and often misdiagnosed as other conditions.
- Diagnosis relies on histopathology, AFB microscopy, and culture.
- Treatment involves surgery and antituberculous therapy.

## Abstract

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.

•Tuberculosis (TB) poses a substantial public health challenge, particularly in developing nations•Involvement of the Calvarium in tubercular disease is rare, and even rarer is primary calvarial tuberculosis•The diagnosis of primary calvarial tuberculosis is challenging and it requires the use of different diagnostic methodologies•The gold standard for diagnosis calvarial tuberculosis is the demonstration of AFB on microscopy and growth on culture•CT scan and MRI is very important in choosing the mode of treatment which usually include chemotherapy (antituberculous) and surgery.

Tuberculosis (TB) poses a substantial public health challenge, particularly in developing nations

Involvement of the Calvarium in tubercular disease is rare, and even rarer is primary calvarial tuberculosis

The diagnosis of primary calvarial tuberculosis is challenging and it requires the use of different diagnostic methodologies

The gold standard for diagnosis calvarial tuberculosis is the demonstration of AFB on microscopy and growth on culture

CT scan and MRI is very important in choosing the mode of treatment which usually include chemotherapy (antituberculous) and surgery.