Primary tubercular osteomyelitis of the sternum

Abstract

Primary tuberculous osteomyelitis of the sternum is a rare clinical entity. Sternal tuberculosis can result from direct extension of the disease from hilar lymph nodes, hematogenous or lymphatic dissemination from other sites, and following BCG vaccination in children. An unusual case of primary tuberculous osteomyelitis of the sternum that presented with a swelling and pain over the manubrium sterni is reported. Diagnosis was confirmed by demonstration of epithelioid granulomas and acid-fast bacilli and a positive M. tuberculosis culture from the aspirate taken from the sternal swelling. Extensive diagnostic work-up did not reveal any other focus of tuberculosis in this case. The patient was successfully managed with anti-tubercular treatment.

Tuberculosis of the manubriosternal joint and concurrent asymptomatic active pulmonary tuberculosis in a patient presenting with a chest wall mass

“…A literature MEDLINE search using the keywords manubriosternal and septic arthritis only revealed 11 isolated case reports published so far, with S. aureus implicated in most of the cases (M. tuberculosis was not implicated in any case) [1]. Tuberculous osteomyelitis of the sternum is also incredibly rare, even in areas where tuberculosis is endemic, and it accounts for less than 1% of cases of musculoskeletal tuberculosis [2]. Since the advent of modern antituberculous therapy, a limited number of detailed cases of tuberculous osteomyelitis of the sternum have been reported.…”

“…Tuberculous osteomyelitis of the sternum is also very rare, even in countries where tuberculosis is endemic, and it accounts for less than 1% of cases of musculoskeletal tuberculosis [2]. Tuberculous involvement of the sternum may be seen as a late complication of pulmonary tuberculosis or as a reactivation of latent foci formed during hematogenous or lymphatic dissemination of primary tuberculosis.…”

Sternal tuberculosis in an immunocompetent adult

“…Bone and joint involvement accounts for 1–3% of tuberculosis cases 4. Sternal osteomyelitis caused by M tuberculosis is a rare entity, accounting for less than 1% of all cases of osteoarticular tuberculosis 4 5. While there are examples of direct extension from contiguous mediastinal lymph nodes, tuberculous sternal osteomyelitis is usually caused by reactivation of latent foci formed during haematogenous or lymphatic dissemination of primary tuberculosis from other sites.…”

“…But, this clinicoradiological picture needs to be differentiated from chronic pyogenic osteomyelitis, tumours, sarcoidosis, actinomycosis and fungal infections 12. Thus, diagnosis relies largely on the results of histological and microbiological examinations of infected tissues 5. This can be accomplished easily by needle aspiration of the swelling with little discomfort to the patient and much less invasive procedures than open biopsy 12.…”

Osteíte por BCG Moreau em uma menina vacinada ao nascer

“…However, it should be noted that BCG Moreau is not as widely used as are other strains, particularly BCG Glaxo and BCG Pasteur-Paris. In Brazil, one group of authors (8) recently reported the case of a normal-weight, (5,10) Involvement of other bones, such as the sternum (11) and the sacrum, (12) is extremely rare. The unilaterality of the disease suggests that circulation was increased (by minimal trauma, for instance) prior to the onset of the bacilli.…”