Sternal tuberculosis in an immunocompetent adult

Abstract

Skeletal tuberculosis accounts for 1-3% of patients with mycobacterial infection. Any bone can be a site for tuberculosis, but sternum involvement is quite rare. We report the case of a 37-year-old woman admitted because of chest pain and increased swelling over the anterior chest. She was immunocompetent and had no systemic features. She was diagnosed with tuberculosis of the sternum without active pulmonary disease. Conservative management with oral multidrug antituberculous therapy completely cured the patient.

Sternal mycobacterial infections

“…As a result, 76 articles[ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 ] were obtained, including 56 (73.7%) case reports,[ 1 3 4 5…”

“…A total of 107 (67.3%) cases were primary,[ 2 5 9 10 13 14 16 17 18 19 21 22 23 28 30 31 32 33 34 38 39 40 42 43 44 48 50 52 53 56 59 60 61 62 64 65 66 67 69 70 72 73 74 75 76 ] 33 (20.8%) were secondary,[ 6 11 12 15 20 24 25 26 29 35 37 46 47 51 55 62 64 66 67 ] and 19 (11.9%) were postoperative. [ 1 3 4 7 8 27 36 41 45 49 54 58 62 63 68 …”

“…Lymphadenopathy was noted in 17 (10.7%) patients,[ 14 16 17 20 27 28 33 34 35 38 46 52 55 65 66 ] of which mediastinal lymphadenopathy was the most common [ Table 6 ].…”

“…In the remaining 98 patients, a standard four-drug regimen was prescribed in 55 (56.1%) patients[ 1 4 5 6 13 14 16 19 22 23 24 27 33 34 35 38 39 40 42 43 44 47 48 50 52 55 57 59 61 64 68 74 ] (28 patients with a successive two-drug[ 14 19 24 25 35 42 44 48 64 74 ] and two patients with a successive three-drug regimen[ 60 ]), a three-drug regimen in seven (7.1%) patients,[ 8 9 10 11 18 28 29 ] a two-drug regimen in two (2.0%) patients,[ 26 63 ] second-line drug in 13 (13.3%) patients,[ 21 32 41 69 ] successive first- and second-line drugs in 14 (14.3%) patients,[ 67 ] adjusted regimen in one (1.0%),[ 54 ] and alternative antibiotic regimen in six (6.1%) patients[ 3 7 46 49 58 ] [ Figure 4 ].…”

Causes systémiques ou originales de douleurs thoraciques

“…Des infections manubrio-sternales peuvent se révéler parfois assez brutalement, de même que des ostéites sternales à staphylocoques [41] ou à bacille tuberculeux [42] du sternum, chez des sujets pourtant immunocompétents.…”