Skull bone lytic lesions: A rare form of multifocal skeletal tuberculosis

Tuberculosis (TB) is a complex disease that can mimic numerous diseases involving different organ systems, making diagnosing TB challenging. Multifocal tubercular osteomyelitis is a rare form of skeletal TB that represents only a minority of all skeletal TB cases. Our patient, a 24-year-old immunocompetent male, complained of a low-grade fever that rises in the evening, scalp aches, right-sided chest pain, and non-inflammatory back pain with rest pain for six months. He had lost six kilograms over this period of illness. He was anemic, with mildly tender swelling in the right parietal region of the scalp. Diffuse tenderness was present over the dorsal spine and right side of the chest, with no evidence of gibbus. Multifocal skeletal tuberculosis was diagnosed based on the presence of lytic lesions in the skull, ribs, and vertebrae, along with high erythrocyte sedimentation rate and high tracer uptake on a bone scan, with a biopsy report showing a granulomatous lesion from the vertebra. After six months of anti-TB therapy, during a scheduled follow-up visit, the patient showed significant improvement in pain and general well-being, with an improvement of the skull lytic lesion on the x-ray. Multifocal tubercular osteomyelitis is rare in immunocompetent males without pulmonary involvement. Early recognition and subsequent treatment could prevent severe complications from bone destruction in these cases.