Multifocal tuberculosis revealed by a sternal swelling in an immunocompetent child

Abstract

Tuberculosis (TB) is one of the most common pathogens of bacterial lung infections, especially in underdeveloped nations like Morocco, where the incidence of TB was 97 cases per 100 000 persons in 2019. Thanks to its national TB prevention and control plan, Morocco was able to achieve remarkable progress in the management of TB with an 80% reduction in the total number of patients diagnosed with TB between 1980 and 2018. The national plan also allowed us to reach and maintain a therapeutic rate above 86% since 2002. Sternal TB is a rare clinical condition accounting for 1% of all musculoskeletal TB cases. Due to its rarity and the lack of awareness of clinical presentations, the diagnosis of sternal TB can be quite complex. We describe the case of a 14-year-old Moroccan patient consulting in the Military Hospital Mohammed V-Rabat with central chest pain for 4 months which was not associated with breathing, physical exercise or eating. The patient also had a history of asthenia, fever and weight loss. A computed tomography scan of the chest showed a destructive lesion of the sternum. Afterward, a chirurgical biopsy was performed and enabled to confirm the microbiological diagnosis of TB with the realization of the real-time PCR. The antitubercular therapy was given to the patient who had complete resolution of symptoms. This condition should be included in the differential diagnosis of chronic chest pain that mimics costochondritis particularly in patients from endemic areas.

Keywords: multifocal tuberculosis; real-time PCR; sternal swelling.

Fig. 1.. Lateral view of the sternal swelling.

Fig. 2.. Chest CT scan showing an osteolytic tissue mass centred on the sternum (left, axial section; right, sagittal section).

Fig. 3.. The appearance of bacilli after Ziehl–Neelsen staining from colonies of liquid medium MGIT.

Fig. 4.. LJ medium showing coloured colonies of 3–4 mm diameter with a cauliflower-like appearance and adherent to the medium.