We report a patient with widespread osteolytic lesions, including exte
nsive involvement of the skull, due to Mycobacterium tuberculosis. Res
ponse to treatment with antituberculosis drugs was slow with appearanc
e of new lesions while on therapy despite a sensitive organism. Excisi
on of diseased skull bone was eventually done, after which no new lesi
ons appeared in the ensuing 14 months.