Anterior Chest Wall Tuberculosis Masquerading as a Chronic Parasternal Sinus in an Apparently Immunocompetent Adult: A Diagnostic Challenge in a Resource-Limited Setting.
Sharmarke Hassan Ali, Mohamed Mukhtar Mohamed, Mustafe Bile Ismail et al.
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Case in brief
A previously healthy 22-year-old man presented with an enlarging parasternal-xiphoid swelling and intermittent seropurulent drainage, without respiratory or constitutional symptoms. CT showed a subcutaneous collection without demonstrated pleural or bone involvement, as well as pulmonary nodules and a tree-in-bud pattern. Fluid Xpert MTB/RIF Ultra detected M. tuberculosis complex at low bacillary load, with no rifampicin resistance detected; histopathology showed caseating granulomatous inflammation. Sputum testing was also positive, supporting concomitant pulmonary tuberculosis. After drainage and debridement, first-line antituberculous therapy was started. The wound closed, and after six months of treatment he was asymptomatic with radiological resolution of the chest wall collection and regression of pulmonary abnormalities.
What made this case unusual
The chest wall tuberculosis presented as a chronic draining parasternal sinus in an apparently immunocompetent patient without constitutional or respiratory symptoms, while imaging showed no demonstrated pleural or osseous involvement.
Diagnostic / clinical pearl
Persistent parasternal swelling or a draining sinus can reflect tuberculosis even without systemic symptoms; fluid or tissue testing and assessment for concomitant pulmonary disease can clarify the diagnosis.