Tuberculous mediastinal abscess as a paradoxical reaction in an immunocompetent individual

Abstract

A 22-year-old man, diagnosed 7 weeks before with pulmonary tuberculosis and started on antitubercular therapy, presented with non-exertional retrosternal chest pain since the past week. He was diagnosed on the strength of thoracic radiograms and CT imaging to have a mediastinal abscess, which was percutaneously drained. He was continued on the same regimen of drugs. Analysis of the fluid obtained was suggestive of tuberculous aetiology. Steroids were not required.

Tuberculous Mediastinitis with Mediastinal Abscess in an Immunocompetent Man Presented with Fever, Acute Dyspnoea, Chest Pain, Chest Wall Swelling, Acute Kidney Injury, Transaminitis and DIC: Rare Case Report

“…Mediastinal tuberculosis is a rare infection resulting from direct inoculation of organisms or through hematogenous spread. Mediastinal abscess due to tuberculosis was reported from rich countries as well as from poor countries [2]. Mediastinal tuberculosis may present as tumour [9].…”

“…Lungs are most commonly affected; lymph node involvement is less common. Clinical awareness on tuberculous infection is important if it involves rare site like extra-pulmonary lesion; furthermore, it makes diagnostic challenges if the clinical presentation is not typi cal [1][2][3]. Among extra-pulmonary lesions, mediastinal tuberculosis is relatively rare [4].…”

An unusual cause of posterior mediastinal cyst

“…[ 10 ] Rarely, can tuberculosis cause mediastinal abscesses. [ 11 12 13 ] This occurs either as a result of extensive necrosis in the conglomerate tuberculous lymph nodes or as a result of a direct extension from a cervical cold abscess. [ 11 12 13 ]…”

“…The location of tuberculous mediastinal abscess is usually in the anterior or middle mediastinum, secondary to extensive involvement of the lymph nodes. [ 12 ] It appears in the paravertebral area when the vertebral column is involved. [ 11 ] The appearance of a cystic lesion in the retrotracheal and paravertebral area without involvement of the spine is unusual.…”