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. This case emphasizes the importance of early clinical suspicion, prompt imaging, and microbiological confirmation-particularly GeneXpert and drug susceptibility testing (DST)-which facilitated timely diagnosis of MDR-TB and improved prognosis. These steps represent a key aspect of diagnostic strategy in pediatric extrapulmonary TB.