Abstract
Abstract: Problem statement: Multifocal Skeletal Tuberculosis (MSTB) is a rare presentation of skeletal tuberculosis. The indolent nature of this condition often leads to delayed or missed diagnosis, sometimes with devastating consequences for the patient. In order to provide meaningful clinical information and to highlight pitfalls in diagnosis of MFST, we present a case of MSTB. A review of this condition is included for broader coverage. Approach: A 30 year old immune-competent male patient with a 1 year history of indolent soft tissue masses on the chest wall overlying the sternum and the ribs. CAT scan of the chest showed multiple lytic bony lesions involving the ribs, sternum and vertebrae that mimicked metastatic cancer. Fine needle aspiration of the lesion revealed AFB and granulomas. Culture of the aspirated material grew mycobacterium tuberculosis and a diagnosis of MSTB was made. Results: A diagnosis of MSTB was made and anti-tuberculous therapy was initiated. Conclusion: This case indicated that multi-focal skeletal tuberculosis may develop in immune-competent patients without overt pulmonary involvement. From our experience along with previously reported data, MSTB should be suspected in patients from endemic areas who present with multiple skeletal bony lesions. Appropriate management and therapy are essentials for cure and to prevent complications.
Highlights
Case report: A 30 year old Filipino man was referred to our outpatient clinic because of two visible masses in the chest wall
Three and 1⁄2 months prior to presentation, he started to have significant chest pain that had increased over the course of three days that required him to go to the Emergency Room (ER), physical examination in the ER was noticeable for tenderness overlying the mid-sternal area and costal cartilages and a poorly circumscribed protuberance overlying on his right lower back, CXR was unremarkable at the time
A suspicion of multi-focal skeletal tuberculosis, especially in patients from endemic areas, should be raised on clinical and radiological basis; a definitive diagnosis can be made by fine needle aspiration biopsy which is simple and safe procedure and obviates the need for an open biopsy
Summary
Case report: A 30 year old Filipino man was referred to our outpatient clinic because of two visible masses in the chest wall. The patient had been well until a year ago when he started to have some discomfort in the right side of his posterior chest wall. Five months prior to his presentation he noticed the appearance of another swelling overlying his sternum (Fig. 1).
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