Tuberculous Frontal Bone Osteomyelitis

A 39 years old man presented with one month history of headache, nausea and vomiting, associated with night sweats without fever or impaired general condition. His past medical history was unremarkable. On admission, the patient was a febrile. A physical examination demonstrated a right frontal bulge which was painful, associated to fluctuation without inflammatory reaction around. A computed tomography (CT) of the brain showed a skin collection (22×5 mm) with osteolytic frontal lesion (Figure 1-3). The tuberculin skin test was positive (12 mm). Laboratory test results, including the complete blood profile and basic metabolic profile, were normal. The chest radiograph was normal. A sputum search of acid-fast bacilli was negative. A neurosurgery was performed: discharge of the abscess with frontal bone biopsy. Histological examination revealed an inflammatory process with epithelioïd granuloma and giant cell associated to a central caseating. The bacteriological examination was not performed. The patient was treated according to the specific sheme for treating bone tuberculosis, as recommended by our authoritis for 12 months. There was a decrease in symptoms with clinical improvement. The cerebral MRI, performed at 11 month of treatment, was normal (Figure 4). The patient is asymptomatic 3 years after the completion of treatment.