Multicentric tuberculosis at two rare sites in an immunocompetent adult

Abstract

The case of a 20-year-old female who presented with refractory coccydynia and sternal pain is described. She was immunocompetent, and had no systemic features. She was diagnosed with tuberculosis of the sternal and coccygeal regions based on magnetic resonance imaging and histopathology of biopsy specimens. Conservative management with oral multidrug antituberculous therapy completely cured the patient, and she had not suffered any recurrence after three years of follow-up. This case highlights the possibility of the multicentric presentation of tuberculosis at two rare sites in the same immunocompetent patient, even though the differential diagnosis was coccydynia.

Fig. 1

Magnetic resonance imaging of the sternal and sacrococcygeal regions. i Destructive lesion in the sternum, ii destructive lesion in the coccyx with an abscess, iii abscess extending into the left gluteal region

Fig. 2

Technetium-99m MDP bone scan of the patient. a Photopenic area with surrounding increased tracer uptake in the sternum. b Photopenic area with surrounding increased tracer uptake in the coccyx