Total Resolution of Large Scalp Swelling due to Calvarial Tuberculosis with Medical Management Only: Case Report and Review of the Literature.

Abstract

Calvarial tuberculosis is rare. It presents with single or multiple discharging sinus or a localized focal scalp swelling with overlying skin discoloration. Usually subgaleal collection is associated with evolution of sinus formation in different stages. However, extensive scalp swelling spreading across bifrontal area and overlying healthy scalp is not reported. Pathologically it causes significant destruction of calvarium including erosion of both the tables with concurrent significant epidural granulation tissue deposits as dura acts as barrier to trans-dural spread. Concurrent surgical management and antitubercular medication is the standard treatment modality. Authors report a unique presentation of calvarial tuberculosis in 17-year- female presented with complaint of large painless scalp swelling extensively spreading over both frontal area from supraorbital margin to coronal suture without discoloration, puckering of overlying scalp or sinus formation, and neuroimaging showed absence of extradural granulation tissue deposits with very subtle bony architecture changes of adjacent calvarium. The swelling completely subsided with medical therapy alone. To the best of knowledge of authors such case of calvarial tuberculosis having large scalp swelling in western literature has not been reported. Clinical presentation, imaging, management and pertinent literature are reviewed.