Pediatric sternal tubercular osteomyelitis presenting as a subcutaneous abscess: A rare entity

Pediatric sternal abscess with associated osteomyelitis is an infrequent but challenging clinical entity. Atypical presentations and negative bacterial cultures compound its diagnosis. This report details a case of a 5-year-old boy who presented with a progressively increasing lower sternal swelling for 1 month. Upon examination, the lesion was suggestive of a sternal abscess. Work-up revealed leukocytosis and a raised erythrocyte sedimentation rate. Magnetic resonance imaging depicted a hyperintense collection in the subcutaneous tissue, extending into the retrosternal space, accompanied by osteomyelitic changes in the manubrium. Surgical drainage of the superficial abscess and curetting of the bony edges of the manubrium, including excision of the sinus tract, were performed. The patient was initiated on anti-tubercular therapy, to which he exhibited a favorable response. The follow-up visits showed adequate healing and new bone formation. Anti-tubercular therapy is a cornerstone for a successful treatment modality for pediatric sternal abscess with tubercular osteomyelitis. Timely intervention and interdisciplinary collaboration are essential for achieving optimal outcomes.