Chest wall tuberculosis (TB) is rare and can often masquerade as a tumour. Diagnostic confirmation is made by bacteriological findings of acid-fast bacilli and culture of Mycobacterium tuberculosis or histopathological findings. This is a 37-year-old immunocompetent lady who presented with a 3-month history of gradually increasing right breast lump with suspicious characteristics during clinical examinations. Ultrasound of the breast showed normal breast tissue with a well-defined hypoechoic lesion within the anterior inferior pectoralis muscle. CT scan of the thorax revealed a right anterior chest wall lesion with multiple lung nodules and consolidations. Thus, there was a high suspicion of chest wall tumour and an initial diagnosis of soft tissue sarcoma was made. Biopsy of the lesion showed necrotising granulomatous inflammation but no acid-fast bacilli. A revised diagnosis of chest wall tuberculosis was made. She attended follow-up complaining of shortness of breath and pleuritic chest pain with signs of right pleural effusion. Her symptoms improved after the initiation of anti-TB treatment. This case demonstrated the challenge in making an early diagnosis of chest wall TB and commencement of anti-TB treatment.

Introduction: Erectile dysfunction (ED) is a serious health problem and an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between physical fitness and ED especially among men with high risk of CVD. Hence, this study aimed to determine the prevalence of ED among men with Metabolic Syndrome (MetS) and its association with hand-grip strength in which is a measurement of physical fitness and muscle strength. Methods: A cross-sectional study was conducted among Malaysian men aged ≥ 40 years who had their follow-up between 1st June 2021 and 30th October 2021 at an institutional primary care clinic in Gombak district, Selangor, Malaysia. The participants were recruited via computer generated simple random sampling. Data on sociodemographic, comorbidities, anthropometry, clinical examinations including hand-grip strength (HGS) and blood chemical profiles were collected. While a validated English and Malay versions of the 5-item International Index of Erectile Function (IIEF-5) were used to assess presence of ED. Multiple logistic regression analysis were conducted to determine the association between sociodemographic, comorbidities, blood chemical profiles, and HGS with ED.Results: There were 334 participants recruited in the study. The mean age was 58.8 (±8.84) years old, with majority were Malays (95.2%, n= 318) and married (98.8 %, n=330). The overall prevalence of self-reported ED was 79% (95% confidence interval [CI]: 0.75-0.84). Multivariable analysis showed that ED was associated with elderly aged ≥ 60 years (odds ratio [OR] 3.27, 95% CI: 1.60-6.69), HGS (OR 15.34, 95% CI: 5.64-41.81) and abnormal total cholesterol (OR 0.36, 95% CI: 0.16-0.78). Conclusion: ED was highly prevalent among Malaysian men aged ≥ 40 years with MetS. Being older than 60 years of age and low HGS are associated with higher risk of ED. Robust screening of ED among men with Mets and intervention to improve muscle strength and physical fitness may be warranted.