title: Tuberculosis of the skull mimicking a bony tumor.
abstract: We present a rare case of calvarial tuberculosis mimicking a solitary bone tumor, which was surgically removed. A 52-year-old female presented with a right forehead swelling, which gradually enlarged over the course of 2 years, with no symptoms or raised intracranial pressure or neurological deficits. Plain and contrast-enhanced brain computed tomography scans were done, revealing a punched-out lesion of the right frontal bone, with a nonenhancing lytic mass. With an initial diagnosis of an intraosseous meningioma, and later on intraoperatively thought to be a metastatic tumor, the mass was excised along with a rim of bone. Histopathological examination results came back as caseous necrosis, highly suggestive of tuberculosis. The patient was then treated with a 1 year regimen of anti-tuberculous medications. Tuberculosis of the cranium is a rare entity, and can mimic tumors or multiple myeloma. A high index of suspicion and knowledge is required for an early diagnosis. A combined surgical and medical therapy is curative.
authors.affiliation: Department of Neurosurgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab II, Kota Bharu, Kelantan, Malaysia.
authors.forename: Fadzlishah Johanabas
authors.initials: FJ
authors.lastname: Rosli
authors.affiliation: Department of Neurosurgery, Hospital Queen Elizabeth II, Kota Kinabalu, Sabah, Malaysia.
authors.forename: Rahmat
authors.initials: R
authors.lastname: Haron
keywords: Calvarial tuberculosis; cranium; mimic; skull