Extensive Multilevel Spinal and Extraspinal Involvement in a Case of Calvarial Tuberculosis: A Rare Disseminated Presentation

Calvarial tuberculosis (TB) is an uncommon manifestation of skeletal TB, and its progression to disseminated involvement of multiple systems is exceedingly rare. We report a unique case of a patient initially diagnosed with calvarial TB, who subsequently developed widespread involvement of the cervical and lumbar spine, bilateral paraspinal soft tissues, the right psoas muscle, and pulmonary parenchyma. Imaging studies demonstrated intraosseous abscesses, soft tissue masses, and compressive epidural components, consistent with disseminated TB. The patient was advised to undergo fluid aspiration for microbiological confirmation and drug susceptibility testing, in view of possible drug-resistant TB. This case underscores the need for high clinical suspicion, early diagnosis, and systemic evaluation in patients with skeletal TB to identify and manage potentially disseminated disease.