Primary calvarial tuberculosis

BACKGROUND: Tuberculosis is a very common disease in India. Its prevalence, capacity to affect every other organ, and atypical presentations make it an important part of the differential diagnosis for cases presenting in the rural setup. Primary tuberculous caries of the calvarium is a rare manifestation of this common entity. CASE DESCRIPTION: A young lady presented with headache and discharging sinus of the scalp. Imaging revealed epidural abscess with midline shift. She underwent surgery, and histopathological diagnosis of tuberculous etiology was made. The pre and intraoperative images, radiological images, and histopathological images are reported and discussed. CONCLUSION: Tuberculosis should be included in the differential diagnosis of the osteolytic lesions of skull with discharging sinus. A high degree of suspicion, especially in patients from low socioeconomic status, is warranted in managing such cases.