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Sternal tuberculosis after open heart surgery.

Pablo Rivas1, Miguel Górgolas, Beatriz Gimena

  • 1Division of Infectious Diseases, Fundación Jiménez Díaz, Madrid, Spain. pablorivasg@hotmail.com

Scandinavian Journal of Infectious Diseases
|July 30, 2005
PubMed
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A rare case of sternal tuberculosis was diagnosed 24 months late in a patient with persistent sternal osteomyelitis. High suspicion is crucial for diagnosing this rare condition alongside common bacterial infections.

Area of Science:

  • Infectious Diseases
  • Surgical Pathology
  • Medical Diagnostics

Background:

  • Sternal osteomyelitis is a serious infection, often occurring post-cardiac surgery.
  • Staphylococcus aureus is a common pathogen in sternal osteomyelitis.
  • Persistent, non-healing sternal wounds require thorough investigation.

Observation:

  • A 68-year-old female presented with a non-healing sternal wound post-aortocoronary bypass.
  • Initial treatment with antibiotics and debridement for presumed Staphylococcus aureus sternal osteomyelitis failed.
  • Diagnosis was delayed by 24 months until sternectomy and cartilage excision.

Findings:

  • Sternal tuberculosis was the underlying cause of the chronic sternal osteomyelitis.
  • The tuberculosis mimicked typical bacterial sternal osteomyelitis, delaying diagnosis.

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  • Surgical intervention was ultimately required for diagnosis and management.

    • Implications:

    • This case highlights the importance of considering rare pathogens in refractory osteomyelitis.
    • A high index of suspicion for tuberculosis is necessary, especially in endemic areas or with atypical presentations.
    • Timely and accurate diagnosis of sternal tuberculosis can prevent prolonged morbidity and extensive surgical procedures.