NIGERIAN INFECTIOUS DISEASES SOCIETY

Abstract

Background: Tuberculosis (TB) is a chronic granulomatous infection that usually involves the lungs, and the hilar lymph nodes. Musculoskeletal TB occurs in 1% to 3 % of persons with TB infection. Tuberculosis of the chest wall constitutes 1% to 5% of all musculoskeletal TB.  We report this case for its rarity.  Case Presentation: A 28-year-old woman presented with two months history of weight loss, four weeks history of fever, sweats and a slowly enlarging painful anterior chest wall swelling. She was treated for pulmonary TB three years prior to onset of his current symptoms. She had been placed on antibiotics in a secondary care facility with no improvement. Examination revealed a young woman who was febrile (38.5?C) with a right sided anterior chest swelling overlying  the sternum. It measured  12 cm x 6cm, tender, warm and fluctuant with intact overlying skin and no discharging sinus. Systemic examination findings were unremarkable. She had  a  normal  blood  sugar;  HIV  screening  test  was  negative  and  she  had  erythrocyte sedimentation  rate of 140 mm in the first hour, and full blood count revealed neutrophilic leukocytosis. Ultrasound scan of the swelling showed fluid collection in the subcutaneous space and  guided  aspiration  revealed  a  purulent  fluid  that  tested  positive  to  Mycobacterium tuberculosis using GeneXpert RIF. She was managed as TB chest wall abscess with a fixed dose combination of rifampicin, isoniazide, pyrazinamide and ethambutol. Surgical drainage of the abscess  yielded  200mls  of  pus.  She  recovered  completely  and  was  discharged home to complete a full course of anti-TB medications.  Conclusions: TB remains a burden in developing countries. Chest wall TB is a rare form of extrapulmonary TB requiring a high index of suspicion to diagnose, and it should be considered in the differential diagnosis when evaluating skin and soft tissue abscesses of the chest wall.