|Year : 2015 | Volume
| Issue : 5 | Page : 165-166
Primary thoracic wall tuberculosis: A rare case
P Sharma1, VK Mehta1, RC Guleria1, D Singh1, A Kanga1, S Mohindroo2
1 Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Submission||22-Feb-2014|
|Date of Acceptance||01-Jul-2014|
|Date of Web Publication||6-Feb-2015|
Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma P, Mehta V K, Guleria R C, Singh D, Kanga A, Mohindroo S. Primary thoracic wall tuberculosis: A rare case. Indian J Med Microbiol 2015;33, Suppl S1:165-6
|How to cite this URL:|
Sharma P, Mehta V K, Guleria R C, Singh D, Kanga A, Mohindroo S. Primary thoracic wall tuberculosis: A rare case. Indian J Med Microbiol [serial online] 2015 [cited 2019 Dec 14];33, Suppl S1:165-6. Available from: http://www.ijmm.org/text.asp?2015/33/5/165/150971
Musculoskeletal tuberculosis accounts for 1-2% of overall tuberculosis cases, of which 1-5% presents with thoracic wall involvement, a rare entity.  We report a case of primary thoracic wall tuberculosis in a 37-year-old female, presented with 3-month history of gradually enlarging lump in upper and outer quadrant of right breast. It was painless initially and became painful after 2 months. There was no history of tuberculosis. Local examination revealed deep-seated mass which was tender, soft in consistency, fluctuant, fixed, with overlying skin appearing normal. Draining axillary lymph nodes were not involved. Patient was HIV negative. Chest roentgenogram was normal. A high-frequency ultrasound demonstrated heterogeneously hyperechoic collection in anterior chest wall below the pectoralis muscle and over ribs of size 5.2 × 2 × 2.6 cms with few liquefied areas. Fine needle aspiration cytology revealed predominantly granular necrotic debris, large number of neutrophils and macrophages [Figure 1].
|Figure 1: Granular necrotic amorphous debris (MGG) May-Grünwald Giemsa: ×10|
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Ziehl-Neelsen (ZN) staining was negative. Mycobacterium tuberculosis was detected in specimen of the aspirated abscess with real time polymerase chain reaction using COBAS ® TaqMan ® MTB Test. Growth was obtained on Lowenstein-Jensen medium after 42 days. On MPT64 immunochromatographic card test, growth was identified as M. tuberculosis complex. Detailed examination ruled out any primary focus in the body. Directly observed treatment short course (DOTS) was started  and patient has shown improvement with complete regression of the thoracic mass.
Atypical presentation, paucibacillary nature and negative AFB smear makes the diagnosis difficult and time consuming, thereby, delaying the initiation of treatment leading to complications and mortality in a treatable disease.  This case emphasises that tuberculosis should be kept in mind as differential diagnosis when a case present with isolated thoracic wall abscess, in immunocompetent persons in endemic areas.
| ~ References|| |
Morris BS, Maheshwari M, Chalwa A. Chest wall tuberculosis: A review of CT appearances. Br J Radiol 2004;77:449-57.
WHO Stop TB Department. Strategy and framework for effective tuberculosis control. Treatment of tuberculosis: Guidelines for national programs. 3 rd
ed. Geneva: World Health Organization; 2003. (document WHO/CDS/TB/2003.313).
Tanaka S, Aoki M, Nakanishi T, Otake Y, Matsumoto M, Sakurai T, et al
. Retrospective case series analysing the clinical data and treatment options of patients with a tubercular abscess of the chest wall. Interact Cardiovasc Thorac Surg 2012;14:249-52.