Sternal Tuberculosis

A 72-year-old man with diabetes and hypertension presented with 6 months of night sweats, fever, hyporexia, malaise, 12-kg weight loss, and a rapidly growing fluctuant mass over the sternum. He had received various empiric antibiotics (clindamycin, amoxicillin, and trimethoprim/sulfamethoxazole) without improvement. Physical examination showed a cachectic man not in distress. Cervical lymphadenopathy and a 10-cm fluctuant presternal chest wall mass were present; there was a fistula draining non-fetid purulent material (Figure 1). The remaining physical examination was normal. Significant laboratory results include negative routine blood cultures, hyperglycemia (278 mg/dL), elevated glycosylated hemoglobin (7%), mild leukocytosis (11,700 cells/mL), normocytic anemia (10.2 mg/dL), and creatinine (2.2 mg/dL). Computed tomography scan of the chest was reported to show erosion of the anterior cortex of the sternum with thickened and inflamed overlying tissue suggestive of chronic osteomyelitis, with substernal abscess. The patient underwent surgical drainage, which demonstrated abundant caseous material. Histologic examination of the sternal bone showed necrosis, granulomas with multinucleated giant cells, and abundant acid-fast bacilli in the fistular and soft tissue material (Figure 2). Molecular testing (Genotype MTBDR) was positive for Mycobacterium tuberculosis sensitive to isoniazid and rifampin. First-line antituberculous treatment was given with good response. Mycobacterial cultures were positive on the clinical specimens. HIV infection and pulmonary tuberculosis (TB) were not found.

• Autores: Cataño Correa, Juan Carlos; Ramírez Sánchez, Isabel Cristina
• Tipo de recurso: Review article
• Fecha de publicación: 2019
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/45785
• Acceso en línea: https://hdl.handle.net/10495/45785
• Palabra clave: 610 - Medicina y salud; Tuberculosis; Linfadenopatía; Lymphadenopathy; Esternón; Sternum; Osteomielitis; Osteomyelitis; Fístula; Fistula; https://id.nlm.nih.gov/mesh/D014376; https://id.nlm.nih.gov/mesh/D000072281; https://id.nlm.nih.gov/mesh/D013249; https://id.nlm.nih.gov/mesh/D010019; https://id.nlm.nih.gov/mesh/D005402; ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades
• Rights: openAccess
• License: http://creativecommons.org/licenses/by/4.0/