title: Neglected Recurrent Scalp Sinus: Calvarial Tuberculosis with Intracranial and Extracranial Extension.
abstract: BACKGROUND
  Calvarial tuberculosis (TB) with intracranial tuberculoma and skin involvement is rare condition even in endemic regions.
  
  
  METHODS
  A 43-year-old man presented with a generalized seizure, altered mental state, scalp swelling, and pus-discharging sinus over the scalp. Magnetic resonance imaging of the brain indicated a conflicting diagnosis of anaplastic meningiomas and chronic osteomyelitis with intracranial extension. Débridement and drainage of intracranial pus was performed. Histopathologic examination revealed TB. After surgery, the patient's general condition improved, and he was started on antitubercular drugs.
  
  
  CONCLUSIONS
  Calvarial TB manifests with various clinical features, and strong clinical suspicion is needed to diagnose and treat it. Only a few cases of calvarial TB with either skin involvement or intracranial extension have been reported in the literature. The present case was challenging to diagnose with a rare presentation involving both intracranial and extracranial extension.
authors.affiliation: Department of Neurosurgery, Apollo Hospitals, Bhubaneswar, Odisha, India. Electronic address: drkrishnabhk.km@gmail.com.
authors.forename: Krishnamurthy B
authors.initials: KB
authors.lastname: Holeppagol
authors.affiliation: Department of Neurosurgery, Apollo Hospitals, Bhubaneswar, Odisha, India.
authors.forename: Biswaranjan N
authors.initials: BN
authors.lastname: Nayak
authors.affiliation: Department of Neurosurgery, Apollo Hospitals, Bhubaneswar, Odisha, India.
authors.forename: Ram Kumar K
authors.initials: RK
authors.lastname: Goyal
authors.affiliation: Department of Neurosurgery, Apollo Hospitals, Bhubaneswar, Odisha, India.
authors.forename: Arunkumar K
authors.initials: AK
authors.lastname: Kumar
authors.affiliation: Department of Neurosurgery, Apollo Hospitals, Bhubaneswar, Odisha, India.
authors.forename: Prafulla K
authors.initials: PK
authors.lastname: Sahoo
authors.affiliation: Department of Neurosurgery, Apollo Hospitals, Bhubaneswar, Odisha, India.
authors.forename: Debabrat
authors.initials: D
authors.lastname: Biswal
mesh_terms: D000328:Adult; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000382:microbiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000150:complications* / Q000601:surgery; D012640:Seizures / Q000209:etiology; D016862:Tuberculoma, Intracranial / Q000150:complications* / Q000601:surgery*; D014394:Tuberculosis, Osteoarticular / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Anaplastic meningiomas; Calvarial tuberculosis; Intracranial abscess; Sinus