Osteomielitis tuberculosa del cráneo, a propósito de un caso

Abstract

Tuberculosis today continues to be a global health problem with high rates of morbidity and mortality, tuberculous osteomyelitis is one of the forms of presentation of extrapulmonary tuberculosis, skull involvement is rare even in endemic areas of tuberculosis, with an approximate incidence from 0.2 to 1.3% of the total cases of skeletal tuberculosis. The most common route of dissemination is hematogenous, from a primary pulmonary focus or by direct inoculation of the bacteria in the affected site; The clinical presentation is similar to other pathologies, but more frequently there is pain, local inflammation and suppuration of the affected site. Early treatment leads to a lower probability of complications at the neurological level, which is why it is important to propose accurate diagnostic methods and adequate therapy. A case of a 45-year-old male patient with a surgical history of craniotomy 6 years ago due to cranioencephalic trauma presents an open wound in the left parietal region with seropurulent fluid and erythematous edges. A sample of the wound secretion is taken, and a computerized axial tomography is requested in the that a lytic image is evident that affects the left parietal bone without alteration of the brain parenchyma in addition to simple and contrast-enhanced nuclear magnetic resonance with diffusion in which a fistula of the scalp is reflected without communication with the endocranial cavity the report of the secretion is positive for acid-fast bacilli, so antituberculous therapy was instituted. A descriptive investigation of a case of tuberculous osteomyelitis of the skull was carried out. To support the information, existing literature on the subject was reviewed in scientific bases such as PubMed, The Cochrane, Intramed, Medline, Scopus, ScieELO, Medigraphic, with a literature cut-off point. than 5 years old, except in cases where the information was essential, it was considered literature of greater antiquity. Due to the low incidence of cases of tuberculous osteomyelitis of the skull and the low relevance given to the subject, it was decided to carry out the report of this case for knowledge of the diagnosis and treatment of this pathology and its consideration for similar cases in the future.