Sternal tuberculosis in an immunocompetent adult

[Sternal tuberculosis: an unusual location of tuberculosis]

INTRODUCTION

Osteo-articular tuberculosis mainly affects the spine. Sternal localization is rare.

CASE REPORT

A 43-year-old man, HIV negative and with a history of tuberculous pleurisy, was seen in a pulmonology consultation for abscesses of the chest wall. The thoracic CT scan revealed multiple antesternal and retrosternal abscesses as well as bone lesions in the sternum, ribs and vertebrae. The diagnosis of sternal tuberculosis was made by microscopy and Xpert MTB/RIF test performed on pus from the abscesses. The progress under anti-tuberculous treatment was favourable.

CONCLUSION

Sternal involvement with tuberculosis is uncommon and rarely detected. The problem is mainly diagnostic. Its therapy is based on anti-tuberculous treatment.

Giant presternal subcutaneous bronchogenic cyst: a rare but possible occurrence

Bronchogenic cysts are generally detected in the mediastinum, along the tracheobronchial tree, or in the lung parenchyma. Subcutaneous presternal bronchogenic cysts have been rarely described, and they are usually of small size (<3 cm) and reported in children. We report a case of giant presternal subcutaneous bronchogenic cyst in a 20-year-old man. Presternal subcutaneous bronchogenic cysts, despite their rarity, should be considered in the differential diagnosis of all subcutaneous cystic masses, independent of their size and the patient's age.

Primary Sternal Osteomyelitis caused by Staphylococcus aureus in an Immunocompetent Adult

Primary sternal osteomyelitis (PSO) is a rare condition that may develop without any contiguous focus of infection. Due to the rarity of the disease, early diagnosis and appropriate treatment are often delayed. Herein, we describe a patient with PSO caused by Staphylococcus aureus that presented with chest pain and fever. The patient had no predisposing factors for sternal osteomyelitis. The chest pain was thought to be non-cardiogenic, as electrocardiography and cardiac enzyme did not reveal ischemic changes when he visited the emergency room. After blood culture revealed the presence of S. aureus, every effort was made to identify the primary focus of infection. Bone scan and magnetic resonance imaging revealed osteomyelitis with soft tissue inflammation around the sternum. After 8 weeks of antibiotics treatment, the patient recovered without any complications.

Sternal mycobacterial infections

Sternal mycobacterial infections are rare. Due to the rarity, its clinical characteristics, diagnoses, and regular management strategies are still scanty. A total of 76 articles on this topic were obtained by a comprehensive literature collection. The clinical features, diagnosis, management strategies and prognosis were carefully analyzed. There were totally 159 patients including 152 (95%) cases of tuberculosis (TB) and seven (5%) cases of non-TB sternal infections. Sternal mycobacterial infections can be categorized into three types: Primary, secondary, and postoperative, according to the pathogenesis; and categorized into isolated, peristernal, and multifocal, according to the extent of the lesions. Microbiological investigation is more sensitive than medical imaging and Mantoux tuberculin skin test in the diagnosis of sternal infections. Most patients show good responses to the standard four-drug regimen and a surgical intervention was necessary in 28.3% patients. The prognoses of the patients are good with a very low mortality. A delayed diagnosis of sternal mycobacterial infections may bring about recurrent sternal infections and sustained incurability. An early diagnosis and prompt antibiotic regimens may significantly improve the patients' outcomes.