Title: The first reported archaeological case with calvarial tuberculosis from the present-day territory of Hungary

Authors: Olga Spekker^1,2, Orsolya Anna Váradi^1,3,4, András Szekeres⁴, Heidi Y. Jäger⁵, Albert Zink⁵, Margit Berner⁶, Doris Pany-Kucera⁶, Liesa Strondl⁶, Paul Klostermann⁶, Levente Samu², Kitty Király¹, Zsolt Bereczki¹, Erika Molnár¹, György Pálfi¹, Balázs Tihanyi^1,3

Affiliations: ¹Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726 Szeged, Hungary; ²Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088 Budapest, Hungary; ³Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54–56, H-1014 Budapest, Hungary; ⁴Department of Microbiology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726 Szeged, Hungary; ⁵Institute for Mummy Studies, Eurac Research, Viale Druso 1, I-39100 Bolzano, Italy; ⁶Department of Anthropology, Natural History Museum Vienna, Burgring 7, A-1010 Vienna, Austria

Abstract: In our presentation, we demonstrate a young adult female (KB67) from the Avar Age (8^th-century-CE) cemetery of Kaba–Bitózug (Hajdú-Bihar county, Hungary), who represents a unique case of osteoarticular tuberculosis (TB) regarding the localisation of the detected bony changes. During the macro- and micromorphological investigations of the skull of KB67, three small, well-circumscribed, punched-out osteolytic lesions were observed in the frontal and left parietal bones that were accompanied by endocranial granular impressions, abnormal blood vessel impressions, periosteal appositions, and cortical erosion. In the postcranial skeleton of KB67, the cervical spine revealed osteolytic lesions, as well as cortical remodelling and erosion, whereas the thoracic and lumbar spine exhibited signs of hypervascularisation.The overall nature and association of the aforementioned pathological bony changes, as well as their resemblance to those of described in previously reported archaeological and modern cases from the pre-antibiotic era imply that the young adult female suffered from multifocal osteoarticular TB. Both the calvaria and the cervical spine represent a rare site of involvement in osteoarticular TB. The morphologically established diagnosis was confirmed by a PCR analysis that provided evidence for the presence of Mycobacterium tuberculosis DNA in the two bone samples taken from the left parietal bone and C6 vertebral body of KB67. In the palaeopathological literature, the number of published calvarial TB cases is scarce. To the best of our knowledge, KB67 is the first reported archaeological case with calvarial TB from the present-day territory of Hungary, who gives us an invaluable insight into the occurrence and natural history of a rare manifestation of osteoarticular TB in the Avar Age of the Great Plain.

Funding: This work was supported by the National Research, Development and Innovation Office (Hungary) (grant agreement n° K 125561) and the „Árpád-ház Program” (grant agreement n° 39509/2018/KFSZ) of the Hungarian Ministry of Human Capacities. This project received funding also from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement n° 856453 ERC-2019-SyG).