Tuberculous Meningoencephalitis with Skull Perforation Possibly Mistaken for Trauma: An Autopsy Case Report

Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.