Tubercular osteomyelitis as scalp swelling and alopecia areata

Tuberculosis (TB) is a well-known endemic disease in developing countries. It continues to be one of the major causes of death and disability in such countries. However, extrapulmonary TB is less common than pulmonary TB. Skeletal TB constitutes about 1% of all tubercular cases. Tubercular osteomyelitis of skull is a rare entity. The most common sites affected are the frontal and parietal bones with destruction of both the inner and outer table. We hereby report a young male presenting to us with scalp swelling in the left frontal region with loss of hair in surrounding areas and in left temporal region. NCCT head was suggestive of osteolytic lesion in frontal bone on left side with accompanying periosteal reaction, consistent with osteomyelitis. In Gene Xpert of pus drained from the swelling, Mycobacterium tuberculosis was detected. Patient was started on Antituberculous treatment, and subsequently improved.