Journal of the Nigerian Infectious Diseases Society

Background: Tuberculosis (TB) is a chronic granulomatous infection that usually involves the lungs, and the hilar lymph nodes. Musculoskeletal TB occurs in $1\mathrm{\%}$ $1\mathrm{\%}$ 1% 1 \% $1\mathrm{\%}$ to $3\mathrm{\%}$ $3\mathrm{\%}$ 3% 3 \% $3\mathrm{\%}$ of persons with TB infection. Tuberculosis of the chest wall constitutes $1\mathrm{\%}$ $1\mathrm{\%}$ 1% 1 \% $1\mathrm{\%}$ to $5\mathrm{\%}$ $5\mathrm{\%}$ 5% 5 \% $5\mathrm{\%}$ 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 $\left({38.5}^{\circ }\mathrm{C}\right)$ $\left({38.5}^{\circ }\mathrm{C}\right)$ (38.5^(@)C) \left(38.5^{\circ} \mathrm{C}\right) $\left({38.5}^{\circ }\mathrm{C}\right)$ with a right sided anterior chest swelling overlying the sternum. It measured $12\mathrm{c}\mathrm{m}\times 6\mathrm{c}\mathrm{m}$ $12\mathrm{c}\mathrm{m}\times 6\mathrm{c}\mathrm{m}$ 12cmxx6cm 12 \mathrm{~cm} \times 6 \mathrm{~cm} $12\mathrm{c}\mathrm{m}\times 6\mathrm{c}\mathrm{m}$ , 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 $140\mathrm{m}\mathrm{m}$ $140\mathrm{m}\mathrm{m}$ 140mm 140 \mathrm{~mm} $140\mathrm{m}\mathrm{m}$ 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 $200\mathrm{m}\mathrm{l}\mathrm{s}$ $200\mathrm{m}\mathrm{l}\mathrm{s}$ 200mls 200 \mathrm{mls} $200\mathrm{m}\mathrm{l}\mathrm{s}$ 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.