Primary tuberculous osteomyelitis of skull presenting as scalp swelling

Background: Tuberculosis in common in developing countries but involvement of skull bone is very rare Incidence of tuberculosis in skeletal system is less than 1 percentage (1, 2, 3). Out of the bone involvement most of them are weight bearing bones however flat and skull bone involvement is very rare. Case presentation: An 18-year-old male presented with headache and swelling over the right temporal region for 15 days. MRI brain contrast was suggestive of lesion hypointense on T1 and Hyperintense on T2 with surrounding ring enhancement present and portion of lesion extending transcranial to outer surface of bone under the scalp. The patient underwent excision of the tumour along with Antitubercular therapy. Conclusion: All patients with Scalp swelling with intracranial extension must be suspected of tuberculous osteomyelitis and related investigations and MRI should be done.