Tuberculosis (TB) is an infectious disease caused by the acid-fast bacillus Mycobacterium tuberculosis that usually affects the lungs, although it may affect other organs (1). Virtually any organs, including the skull, can be affected by tuberculosis. The risks of acquiring tuberculosis have been escalating currently because of rampant malnutrition, poor socioeconomic conditions, and immunodeficiency syndromes like Human Immunodeficiency Virus (HIV). Tuberculosis is the leading cause of death among people living with HIV, accounting for one in five HIV-related deaths (2). The importance of timely diagnosis would provide opportunities for the earlier initiation of treatment for people infected with tuberculosis. However, for people living with HIV, testing with conventional sputum AFB smear more often than not turns out to be negative. While the time tested sputum culture for tuberculosis serves as the gold standard for the diagnosis, the long incubation period poses a delay in the diagnosis. Another drawback is that drug resistance rates especially to the first line drugs are rising and doing a drug susceptibility test is a slow and cumbersome process.

In 2010, WHO recommended the use of the rapid TB test, known as the GeneXpert MTB/RIF system, which is a rapid, fully-automated diagnostic molecular test to detect the presence of Mycobacterium tuberculosis and rifampin resistance. We report a case of an HIV patient who was diagnosed with calvarial tuberculosis using the molecular GeneXpert MTB/RIF system.