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Case Reports
. 2020 Nov 11:2020:8884770.
doi: 10.1155/2020/8884770. eCollection 2020.

Chest Wall Mass in Infancy: The Presentation of Bone-Tumor-Like BCG Osteitis

Phumin Chaweephisal  1 , Teesit Torchareon  2 , Shanop Shuangshoti  3 , Piti Techavichit  1
Affiliations
Case Reports

Chest Wall Mass in Infancy: The Presentation of Bone-Tumor-Like BCG Osteitis

Phumin Chaweephisal et al. Case Rep Pediatr. .

Abstract

Chest wall mass in infancy is rare. Malignant lesions are more common than infection or benign tumors. This is a case of a 12-month-old girl who presented with a 2 cm mass at the right costal margin and poor weight gain. Chest radiograph demonstrated a moth-eaten osteolytic lesion at the 8th rib. The resection was performed, and a mass with pus content was found. The positive acid fast stain (AFB) organism was noted. Pathology confirmed caseous granulomatous inflammation compatible with mycobacterial infection. However, QuantiFERON-TB Gold was negative, so Mycobacterium bovis (M. bovis) osteitis is highly suspected. She was treated with antimycobacterium drugs and showed good results. Osteomyelitis can manifest by mimicking bone tumors. Without a biopsy, the pathogen may go undetected. So, interventions such as biopsy are warranted and avoid mass resection without indication. High C-reactive protein (CRP), alkaline phosphatase (ALP), periosteal reaction of radiating spicules, and penumbra sign in magnetic resonance imaging (MRI) are helpful for discriminating osteomyelitis from bone tumor.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Chest radiograph demonstrated moth-eaten osteolytic lesion at the right anterior 8th rib.
Figure 2
Figure 2
Chest MRI shows lobulated irregular rim-enhancing lesion epicenter with destruction of the right lateral 8th rib causing pressure effect to right hepatic lobe. Penumbra sign is positive.
Figure 3
Figure 3
Microscopic examination showed granulomatous inflammation with caseous necrosis.
See this image and copyright information in PMC

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