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Chest Wall Mass in Infancy: The Presentation of Bone-Tumor-Like BCG Osteitis

Phumin Chaweephisal1, Teesit Torchareon2, Shanop Shuangshoti3

  • 1STAR Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Case Reports in Pediatrics
|January 11, 2021
PubMed

Insights

A rare infant chest wall mass was diagnosed as Mycobacterium bovis osteitis, mimicking a bone tumor. Prompt biopsy and antimycobacterial treatment led to positive outcomes, highlighting diagnostic challenges in pediatric bone infections.

Area of Science:

  • Pediatric Oncology
  • Infectious Diseases
  • Skeletal Radiology

Background:

  • Chest wall masses in infants are uncommon, with malignant lesions often considered more frequent than infectious or benign etiologies.
  • Early and accurate diagnosis is crucial for effective treatment and improved patient outcomes in pediatric cases.

Observation:

  • A 12-month-old girl presented with a right costal margin mass, poor weight gain, and a moth-eaten osteolytic lesion on chest radiograph.
  • Surgical resection revealed a pus-filled mass, with positive acid-fast bacilli (AFB) staining, suggestive of mycobacterial infection.

Findings:

  • Pathology confirmed caseous granulomatous inflammation, consistent with mycobacterial infection, but a negative QuantiFERON-TB Gold test raised suspicion for Mycobacterium bovis osteitis.
  • The patient responded well to antimycobacterial drug therapy.

Implications:

  • Osteomyelitis can present symptomatically and radiographically similar to bone tumors, underscoring the importance of biopsy for pathogen identification.
  • Imaging findings like periosteal reaction and MRI signs, alongside inflammatory markers (CRP, ALP), aid in differentiating osteomyelitis from bone tumors.

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