Anterior Chest Wall Tuberculosis Masquerading as a Chronic Parasternal Sinus in an Apparently Immunocompetent Adult: A Diagnostic Challenge in a Resource-Limited Setting.
- 1Department of Thoracic Surgery, Mogadishu Somalia Turkiye Training and Research Hospital, Mogadishu, Somalia.
- 2Department of Emergency Medicine, Mogadishu Somalia Turkiye Training and Research Hospital, Mogadishu, Somalia.
- 3Faculty of Medicine and Health Sciences, Hormuud University, Mogadishu, Somalia.
Abstract
Anterior chest wall tuberculosis is an uncommon form of extrapulmonary tuberculosis that can mimic a chronic pyogenic abscess or chest wall mass. Its indolent presentation and absence of constitutional symptoms may delay diagnosis, particularly in resource-limited settings. A 22-year-old previously healthy male soldier presented with a progressively enlarging parasternal-xiphoid swelling and intermittent seropurulent discharge, without respiratory or constitutional symptoms. Examination revealed a minimally tender 5 × 2 cm fluctuant swelling with a draining sinus and localized skin changes. Thoracic computed tomography showed a 57 × 18 mm subcutaneous collection at the xiphoid level without demonstrated pleural or osseous involvement, alongside centrilobular nodules and a tree-in-bud pattern suggestive of pulmonary infection. Incision, drainage, and debridement were performed. Xpert MTB/RIF Ultra testing of a fluid specimen detected Mycobacterium tuberculosis complex at a low bacillary load, without rifampicin resistance detected. Histopathological examination was reported to show caseating granulomatous inflammation with multinucleated giant cells. Sputum testing was also positive for M. tuberculosis, supporting concomitant pulmonary tuberculosis. First-line antituberculous therapy was initiated. The wound was closed at the 14-day postoperative assessment. Following six months of treatment, the patient remained asymptomatic; follow-up computed tomography demonstrated resolution of the chest wall collection and regression of pulmonary abnormalities. Chest wall tuberculosis should be considered in patients with persistent parasternal swelling or a draining sinus, even without constitutional or respiratory symptoms. Tissue sampling, molecular and histopathological evaluation, and assessment for concomitant pulmonary disease support timely diagnosis and appropriate treatment.
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BibTeX
@article{ali2026anterior,
title = {{Anterior Chest Wall Tuberculosis Masquerading as a Chronic Parasternal Sinus in an Apparently Immunocompetent Adult: A Diagnostic Challenge in a Resource-Limited Setting.}},
author = {Sharmarke Hassan Ali and Mohamed Mukhtar Mohamed and Mustafe Bile Ismail and Abdikani Ali Salad},
journal = {International medical case reports journal},
year = {2026},
month = nov,
doi = {10.2147/imcrj.s645299},
url = {https://europepmc.org/article/MED/42999807},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Anterior Chest Wall Tuberculosis Masquerading as a Chronic Parasternal Sinus in an Apparently Immunocompetent Adult: A Diagnostic Challenge in a Resource-Limited Setting.
AU - Sharmarke Hassan Ali
AU - Mohamed Mukhtar Mohamed
AU - Mustafe Bile Ismail
AU - Abdikani Ali Salad
PY - 2026
DA - 2026/11/03
JO - International medical case reports journal
DO - 10.2147/imcrj.s645299
UR - https://europepmc.org/article/MED/42999807
AB - Anterior chest wall tuberculosis is an uncommon form of extrapulmonary tuberculosis that can mimic a chronic pyogenic abscess or chest wall mass. Its indolent presentation and absence of constitutional symptoms may delay diagnosis, particularly in resource-limited settings. A 22-year-old previously healthy male soldier presented with a progressively enlarging parasternal-xiphoid swelling and intermittent seropurulent discharge, without respiratory or constitutional symptoms. Examination revealed a minimally tender 5 × 2 cm fluctuant swelling with a draining sinus and localized skin changes. Thoracic computed tomography showed a 57 × 18 mm subcutaneous collection at the xiphoid level without demonstrated pleural or osseous involvement, alongside centrilobular nodules and a tree-in-bud pattern suggestive of pulmonary infection. Incision, drainage, and debridement were performed. Xpert MTB/RIF Ultra testing of a fluid specimen detected Mycobacterium tuberculosis complex at a low bacillary load, without rifampicin resistance detected. Histopathological examination was reported to show caseating granulomatous inflammation with multinucleated giant cells. Sputum testing was also positive for M. tuberculosis, supporting concomitant pulmonary tuberculosis. First-line antituberculous therapy was initiated. The wound was closed at the 14-day postoperative assessment. Following six months of treatment, the patient remained asymptomatic; follow-up computed tomography demonstrated resolution of the chest wall collection and regression of pulmonary abnormalities. Chest wall tuberculosis should be considered in patients with persistent parasternal swelling or a draining sinus, even without constitutional or respiratory symptoms. Tissue sampling, molecular and histopathological evaluation, and assessment for concomitant pulmonary disease support timely diagnosis and appropriate treatment.
SN - 1179-142X
ER -