Calvarial tuberculosis - a case report

Abstract

Tuberculosis is an infectious disease caused by acid fast bacilli, Mycobacterium tuberculosis that usually affects the lung although it may affect any organ. Tuberculous osteitis of the cranial bone is known as calvarial tuberculosis. The disease is considered secondary to an active or latent tuberculous lesion elsewhere in the body, but direct spread from orbit, paranasal sinuses and face has also been implicated. Though tuberculosis is endemic in Bangladesh, calvarial tuberculosis is very very rare. We report a case of a female, diabetic, hypertensive, chronic kidney disease(CKD), bronchial asthma patient presented with osteolytic lesion in skull with adjacent subcutaneous swelling. She was eventually diagnosed as calvarial tuberculosis on the basis of positive MTB- PCR from the pus aspirated from the swelling.Bangladesh Crit Care J March 2016; 4 (1): 41-43

A rare extrapulmonary manifestation of tuberculosis in a chronic kidney disease patient

“…Developed nations report intracranial tuberculomas as the cause of 0.15%–4% of all intracranial space‐occupying lesions, whereas in developing nations, they are responsible for 30%–34% of such lesions 9,10 . Among these, calvarial involvement is seen in 0.2%–1.3% of the affected individuals with skeletal TB 11 …”

“…Tuberculomas occur secondary to a primary infection, the focus usually being lungs or lymph nodes. The mode of spread is through the hematogenous route 11 . It can occur from granuloma in the parenchyma or through the spread of foci from the meninges to the brain parenchyma.…”

“…11 A history of tubercular meningitis is not a necessity for the diagnosis of tuberculoma. 11 Tuberculomas are slow-growing lesions, that can be single or multiple with a thicker wall compared to a pyogenic abscess. 16,17 They can have varied clinical presentations.…”

Incidental Tuberculoma in a Chronic Kidney Disease Patient: A Rare Extra-Pulmonary Manifestation of Tuberculosis

“…However, in developing countries, they account for 30-34% of intracranial space-occupying lesions [9,11]. Among these, calvarial involvement is seen in 0.2-1.3% of the affected individuals with skeletal TB [10]. There have been many case reports showing an increased incidence of tuberculoma in patients with CKD and patients on hemodialysis [12].…”

“…The granulation tissue replaces the bony trabeculae and the capillary is seen. Concentrically placed proliferating fibroblasts contain the spread of infection to either table [10]. A history of tubercular meningitis isn't a necessity for the diagnosis of tuberculoma.…”