Multifocal tuberculosis of the chest wall without pulmonary involvement

Area of Science:

• Pediatrics
• Infectious Diseases
• Orthopedics

Background:

• Skeletal tuberculosis (TB) often presents with a primary pulmonary infection.
• However, extrapulmonary TB, particularly skeletal TB without lung involvement, is increasingly recognized, especially in pediatric cases.
• Sternal TB in infants is frequently linked to Bacillus Calmette-Guerin (BCG) vaccination.

Observation:

• This report details a case of rib tuberculosis and a cold abscess in a child.
• The child had a history of sternal TB, which was previously undiagnosed.
• This highlights the potential for missed diagnoses of solitary skeletal lesions.

Findings:

• The case illustrates multifocal skeletal TB developing from an initially unrecognized sternal lesion.
• This progression suggests that isolated bone TB can disseminate if not promptly identified and treated.
• The development of a cold abscess indicates advanced, untreated tuberculous osteomyelitis.

Implications:

• Prompt diagnosis and treatment of seemingly isolated skeletal TB lesions in children are essential.
• Early intervention may prevent the progression to multifocal skeletal TB.
• This underscores the importance of considering skeletal TB in children presenting with bone lesions, even in the absence of pulmonary symptoms.