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Anterior Chest Wall Tuberculosis Masquerading as a Chronic Parasternal Sinus in an Apparently Immunocompetent Adult: A Diagnostic Challenge in a Resource-Limited Setting

Year: 2026

Type: article

Abstract: Background: Anterior chest wall tuberculosis is an uncommon form of extrapulmonary tuberculosis that can mimic a chronic pyogenic abscess or chest wall mass. Its indolent presentation and absence of constitutional symptoms may delay diagnosis, particularly in resource-limited settings. Case Presentation: A 22-year-old previously healthy male soldier presented with a progressively enlarging parasternal–xiphoid swelling and intermittent seropurulent discharge, without respiratory or constitutional symptoms. Examination revealed a minimally tender 5 × 2 cm fluctuant swelling with a draining sinus and localized skin changes. Thoracic computed tomography showed a 57 × 18 mm subcutaneous collection at the xiphoid level without demonstrated pleural or osseous involvement, alongside centrilobular nodules and a tree-in-bud pattern suggestive of pulmonary infection. Incision, drainage, and debridement were performed. Xpert MTB/RIF Ultra testing of a fluid specimen detected Mycobacterium tuberculosis complex at a low bacillary load, without rifampicin resistance detected. Histopathological examination was reported to show caseating granulomatous inflammation with multinucleated giant cells. Sputum testing was also positive for M. tuberculosis , supporting concomitant pulmonary tuberculosis. First-line antituberculous therapy was initiated. The wound was closed at the 14-day postoperative assessment. Following six months of treatment, the patient remained asymptomatic; follow-up computed tomography demonstrated resolution of the chest wall collection and regression of pulmonary abnormalities. Conclusion: Chest wall tuberculosis should be considered in patients with persistent parasternal swelling or a draining sinus, even without constitutional or respiratory symptoms. Tissue sampling, molecular and histopathological evaluation, and assessment for concomitant pulmonary disease support timely diagnosis and appropriate treatment. Keywords: anterior chest wall tuberculosis, cold abscess, parasternal sinus, extrapulmonary tuberculosis, xpert MTB/RIF ultra, pulmonary tuberculosis, resource-limited setting, case report

Source: International Medical Case Reports Journal

DOI: 10.2147/imcrj.s645299

Authors: Sharmarke Hassan Ali, Mohamed Mukhtar Mohamed, Mustafe Bile Ismail, Abdikani Ali Salad

Institutions: Mogadishu Somali Turkish Training and Research Hospital, Hormuud University

Language: English

Topic: Tuberculosis Research and Epidemiology

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,320