A 9-year-old boy had an increase in abdominal volume associated with nonspecific abdominal pain and fever for 2 months, evolving without improvement of symptoms, so he was admitted for investigation presenting a swelling in the left foot. After 3 weeks the patient presented a painless swelling of frontal region, without other signs of inflammation or cervical lymph node enlargement. Painful swelling also appeared in the left ankle. There was no epidemiological history of TB. TST with PPD Rt23 was 11 mm and the HIV-test was negative. Chest X-ray was normal; chest CT revealed the presence of 1.1 cm lymph nodes in the pre-tracheal region, 0.8-1.1 cm near the right anterior costophrenic sinus and other smaller lymph nodes in anterior mediastinum and infracarinal region. In addition, there was a small right pleural effusion without lesions in pulmonary parenchyma. Ultrasonography and abdominal CT performed one week before revealed the presence of a moderate ascite, enlarged liver (regular contour and homogeneous density), small lymph nodes along the right common iliac vessels and 1.9 x 1.2 cm nodular image next to the left diaphragmatic dome (probably a lymph node). The cranial CT showed a frontal lytic lesion in the midline measuring 2 cm and a thickness of 0.7 cm; the internal bone layer was intact and there was a rupture of the external plate extending beyond the extra-cranial layer (Figure 3). The extracranial segment had a soft tissue density of 1.6 x 0.7 cm, with normal cerebral parenchyma, ventricular system and cisterns. The skull biopsy showed a chronic inflammatory process with granuloma and multinucleated giant cells; Ziehl Neelsen, Groccot and PAS staining did not show microorganisms. A left ankle synovium biopsy was also performed. The Xpert MTB/RIF test on synovium material for Micobacterium tuberculosis complex was positive. The patient underwent an immunological investigation but it was not possible to show an altered functional assay for the IFN-g/IL12 axis, with no response to either cytokine.