Primary tubercular chest wall abscess in a young immunocompetent male.

Shweta Sharma,Nandini Duggal,B B Sharma,V P Myneedu,R K Mahajan

doi:10.1155/2014/357456

Abstract

Chest wall tuberculosis is a rare entity especially in an immunocompetent patient. Infection may result from direct inoculation of the organisms or hematogenous spread from some underlying pathology. Infected lymph nodes may also transfer the bacilli through lymphatic route. Chest wall tuberculosis may resemble a pyogenic abscess or tumour and entertaining the possibility of tubercular etiology remains a clinical challenge unless there are compelling reasons of suspicion. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. We present here a case of chest wall tuberculosis where infection was localized to skin only and, in the absence of any evidence of specific site, it appears to be a case of primary involvement.

Highlights

Tuberculosis (TB) is a major public health problem with associated high morbidity and mortality if not treated adequately, especially in the developing countries like India which accounts for one-fourth of the global incident TB cases annually
Diagnosis of chest wall tuberculosis is often arduous since clinical presentation may resemble pyogenic abscess and since Mycobacteria other than tuberculosis (MOTT) are important causes of skin infections failure to respond to conventional anti-tubercular therapy (ATT) may further complicate the diagnosis
Three mechanisms are described in the pathogenesis of chest wall abscess: direct extension from pleural or pulmonary parenchymal disease, hematogenous dissemination of a dormant tuberculous focus, or direct extension from lymphadenitis of the chest wall [4, 5]

Summary

Introduction

Tuberculosis (TB) is a major public health problem with associated high morbidity and mortality if not treated adequately, especially in the developing countries like India which accounts for one-fourth of the global incident TB cases annually. As per the WHO Global Report on tuberculosis in 2013, 20% of all the freshly diagnosed cases in India are extrapulmonary. Diagnosis of chest wall tuberculosis is often arduous since clinical presentation may resemble pyogenic abscess and since MOTT are important causes of skin infections failure to respond to conventional ATT may further complicate the diagnosis. We are presenting a case of primary tubercular abscess in the chest wall of a 16-year-old boy where the bacilli appeared to have got directly deposited on the damaged skin from an open case of tuberculosis in the family and evolve into a fully developed abscess

Case Report

Discussion