Tuberculosis of the scalp in a 13-year-old child: A common entity at an uncommon location – A rare case report

Tuberculosis (TB) caused by Mycobacterium tuberculosis manifests as pulmonary and extrapulmonary forms with cutaneous TB being rare and TB of scalp even rarer. We report the case of a 13-year-old girl who was admitted with a 4-week history of painful swelling and ulcer on the scalp and occasional cough. She had a history of falling on the head 6 months ago. On physical examination, the ulcer measured 6 cm in diameter and was tender with a yellowish-white crust. Contrast-enhanced computed tomography of the head showed a well-defined hypodense peripherally enhancing lesion overlying the left parietal bone with the destruction of the underlying bone. A clinical diagnosis of frontal bone osteomyelitis was made. Abscess drainage was done with excision of the lesion which on histopathological examination showed abundant necrosis with few ill defined epithelioid cell granulomas, langhans type of giant cells, and chronic inflammatory infiltrates. Ziehl–Neelsen staining for acid-fast bacilli was negative, whereas molecular testing by GeneXpert Rifampicin Assay was positive for M. tuberculosis. Thus, a diagnosis of tubercular osteomyelitis was made. Our patient was prescribed four drugs antitubercular regimen for 1 year. On follow-up after 6 months, she is doing fine without any signs and symptoms of the disease. TB should always be kept in mind as the differential diagnosis keeping its varied presentation and high prevalence in our country.