The presence of post traumatic tubercular osteomyelitis in the skull vault is unusual. This rare extrapulmonary disease was first described by Reid in 1842. The condition is often diagnosed in a road traffic accident. The patient was conscious and oriented, but had a lacerated right ear. He had a history of TB, which he was referred for as a ‘disabling illness.’
A study published in 2006 suggested a possible connection between pyogenic and tubercular osteomyelitis in children. It found that a large proportion of TB patients were younger than 20 years old. Moreover, the incidence of TB of the skull bone is increasing in developing countries, which is associated with malnutrition and a poor socioeconomic status. The disease usually involves the frontal bones, but it is rare in the zygoma.
Although tubercular osteomyelitis in the skull vault is uncommon, it can be difficult to differentiate it from pyogenic osteomyelitis due to the lack of pathological signs and symptoms. In some cases, the infection can be asymptomatic. Surgical curettage and four-drug antitubercular therapy are usually recommended. These treatments are highly effective in treating post traumatic tubercular osteomyelitis in the head and neck.
The clinical presentation of TB osteomyelitis in the skull vault is similar to that of pyogenic osteomyelitis. The signal characteristics of tuberculous osteomyelitis are low T1, high T2 and variable. In a study of eleven cases, the T1 signal was elevated in the peripheral rim, and the T2 signal was low to intermediate. The patient was diagnosed with post traumatic tubercular osteomyelitis in the skull vault.
Treatment for tubercular osteomyelitis of the skull vault varies from case to case. The disease is characterized by a variety of pathological symptoms, including the presence of a pus-filled pus-like discharge. Typically, the resulting skeletal deterioration can be treated with antibiotics and surgical curettage. The condition does not require surgical curettage, but it requires four-drug antitubercular therapy to prevent recurrence.
Treatment for tubercular osteomyelitis is primarily medical and includes antibiotics for secondary infections. However, antituberculous chemotherapy is often ineffective in patients with TB osteomyelitis of the skull. Similarly, an anticonvulsant should be considered in patients with symptoms of the disease. Nonetheless, the diagnosis of TB osteomyelitis is highly controversial.
Radiological findings indicate a high-signal-intensity soft tissue mass in the left orbit, which is consistent with the diagnosis of tubercular osteomyelitis. CECT of the head and neck revealed an ill-defined bone-shaped lesion suggestive of osteomyelitis. MRI of the patient’s skull vault has shown a high-signal intensity soft tissue mass, which is characteristic of an infected bone.