Published online Dec 28, 2014. doi: 10.4329/wjr.v6.i12.928
Revised: September 1, 2014
Accepted: November 7, 2014
Published online: December 28, 2014
A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.
Core tip: Clinicians must maintain a high index of suspicion of Mycobacterium tuberculosis in the immigrant population and other high-risk groups, and must be considered a causative agent of fevers in the retuning traveller. TB osteomyelitis/arthritis is much more indolent clinically and radiologically than bacterial osteomyelitis/arthritis, and therefore, a high index of suspicion must be maintained in individuals immigrating and who have compromised immune function.