Background and aim Tuberculosis is a highly prevalent disease in Brazil, but cranial bone presentation are extremely rare. We describe a case report of atypical cranial bone tuberculosis in a tertiary care teaching hospital in Rio de Janeiro, Brazil.
Methods PHGR, 4 years age, male, caucasian, born and raised in Saquarema, RJ, Brazil. The patient was admitted in September 2013 with back pain, fever, spleen and liver nodular lesions. Multiple osteolytic lesions were also found, more importantly in C6, C7 and cranial bone. A hepatic biopsy showed granulomatous hepatitis. Due to the cervical severity lesions, an empiric treatment for tuberculosis with RIP (Rifampicine, Isoniaside and Pirazinamide) began. Sixty days after treatment progressive improvement of all osteolytic lesions except on the cranial bone and calcified spleen and liver granulomas were observed. A cranial bone biopsy showed new granulomas and BAAR were visualised. After 5 months of RIP treatment the cranial bone lesions began to fade. He had not received the BCG vaccine (Calmet-Guerrin Baccilus) despite of this being part of the official brazilian immunisation schedule. The child has also been evaluated for Mendelian susceptibility to mycobacterial diseases.
Results We present a case of multisystemic tuberculosis in a boy with cranial bone compromising.