Font Size: 

Multifocal skeletal tuberculosis (TB) involving the skull and atlantoaxial region is rare. Only two pediatric cases have been reported in literature. Due to this rarity, the paper aims to increase the awareness of the medical practitioners regarding the disease.Our patient is a 12-year old female presenting with an 8-month history of nape pain, headache, recurrent ear discharge and hearing loss. Both cranial MRI and head and cervical neck contrast-enhanced CT scan showed multiple lytic lesions in the skull and left lateral mass of the first cervical vertebra (C1) associated with subluxation of C1 over C2 vertebra. Langerhans Cell Histiocytosis (LCH) was initially considered. Multisystem involvement of the ears, lungs, gastrointestinal and lymph node and the neuroimaging results did not clearly differentiate LCH from TB. However, histopathological examination and culture of the external auditory canal and skull masses confirmed the presence of TB infection. The patient underwent cervical neck stabilization and was started on quadruple anti-tubercular therapy.Thus, tuberculosis should always be considered as a differential diagnosis in patients presenting with multiple lytic lesions who have a known close contact to a source case residing in endemic areas.

Multifocal Skeletal Tuberculosis; Langerhans Cell Histiocytosis