Objectives: M. bovis is an infrequent cause of CNS tuberculosis in our country, with few cases described in the literature. Since compulsory pasteurization of milk and implementation of eradication programs on infected cattle, human sporadic illness with this organism has dramatically declined in developed countries.

Methods: A 71-year-old male was attended at the emergency room due to a traumatic brain injury (TBI) after an accidental fall. Cranial axial computerized tomography (CT) was performed, which revealed a calvarial lytic bone lesion, with no other relevant findings. Physical and neurological examination was unremarkable, but given the medical history and the radiological findings, the study was completed with a cranial magnetic resonance image (MRI). MRI showed a lytic lesion in the right frontal bone with a small epidural collection.

Results: A craniotomy of the lesion was performed and the microbiology results were positive for M. bovis, therefore antituberculous therapy was initiated. Despite of the correct treatment, the patient developed a tuberculous abscess that required an aggressive surgical management followed by a suppurative fistula. Based on the treatment of tuberculous lymphadenitis, we decided to perform a conservative management with ATT (R + I + E + moxifloxacin + steroids during 12 months) and avoided new surgical cleanings of the surgical bed obtaining a good response and a good clinical evolution.

Conclusions: As far as we know, this is the first case reported of a supurative fistula after the resection of a cerebral abscess caused by M. bovis, therefore, there is no report in the literature about the treatment of this complication.