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Anterior chest wall tuberculous abscess: a case report
© Papavramidis et al; licensee BioMed Central Ltd. 2007
Received: 22 July 2007
Accepted: 26 November 2007
Published: 26 November 2007
The granulomatous inflammation of tuberculosis usually involves the lungs and the hilar lymph nodes. Musculoskeletal tuberculosis (TB) occurs in 1–3% of patients with TB, while TB of the chest wall constitutes 1% to 5% of all cases of musculoskeletal TB. Furthermore, nowadays it is rarer to find extrapulmonary TB in immunocompetent rather that non-immunocompetent patients. The present case reports a fifty-six-year-old immunocompetent man with an anterior chest wall tuberculous abscess. The rarity of the present case relates both to the localization of the tuberculous abscess, and to the fact that the patient was immunocompetent. The diagnosis of musculoskeletal tuberculous infection remains a challenge for clinicians and requires a high index of suspicion. The combination of indolent onset of symptoms, positive tuberculin skin test, and compatible radiographic findings, strongly suggests the diagnosis. TB, however, must be confirmed by positive culture or histologic proof. Prompt diagnosis and treatment are important to prevent serious bone and joint destruction.
Musculoskeletal tuberculosis (TB) occurs in 1–3% of patients with TB [1, 2], while TB of the chest wall constitutes 1% to 5% of all cases of musculoskeletal TB . Tuberculous tendon and muscle infection may result from direct inoculation or hematogenous dissemination from a primary focus such as the lung .
This case report is interesting because it reports a case of chest wall TB in an immunocompetent patient.
Tuberculous abscesses of the chest wall can involve the sternum, costochondral junctions, rib shafts, costovertebral joints and the vertebrae. They are most frequently found at the margins of the sternum and along the rib shafts . The parasternal region, costovertebral junction, and vertebra are involved less frequently . Chung et al. have previously reported CT scanning to be a useful tool for investigation in the diagnosis of a tuberculous retromammary abscess and also in determining the extent of an abscess . Our case involved a tuberculous abscess which extended between the pectoralis muscles with involvement and erosion of the costal cartilage.
Tuberculous muscle infection may result from direct inoculation or hematogenous dissemination from a primary focus such as the lung . The onset of symptoms of tuberculous tenosynovitis is typically gradual, with slow progressive swelling, ensuing pain, and decreased range of motion [7–9]. In our case the patient had had the tuberculoma for at least 15 years without symptoms, but had then experienced a rapid augmentation of its volume over the last 3 months.
Tuberculous infections have been increasing in incidence during the last decades for a variety of reasons, including increasing numbers of patients with immunity-depressive diseases, drug resistance, aging population, and health care worker exposure . None of the above was relevant in this case of TB however our patient was an immigrant from an area with a high prevalence of TB.
The granulomatous inflammation of tuberculosis usually involves the lungs and the hilar lymph nodes, and anterior chest wall involvement is very rare. Furthermore, nowadays it is rarer to find extrapulmonary TB involving immunocompetent patients than non-immunocompetent. The diagnosis of musculoskeletal tuberculous infection remains a challenge for clinicians and requires a high index of suspicion. The combination of indolent onset of symptoms, positive tuberculin skin test, and compatible radiographic findings, strongly suggests the diagnosis. TB treatment is often started immediately after the appropriate microbiological and histological samples have been obtained if the clinical suspicion is high. TB, however, must be confirmed by positive culture or histologic proof. Prompt diagnosis and treatment are important to prevent serious bone and joint destruction.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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