Introduction: Primary sternal osteomyelitis caused by Mycobacterium tuberculosis is a rare manifestation of extrapulmonary tuberculosis. Case presentation: We present a case of isolated sternal tuberculosis and review the demographic, clinical, diagnostic and therapeutic features of 32 published cases found in a systematic review of the literature. Patients with primary sternal osteomyelitis due to M. tuberculosis are often young and have no co-morbidity. Diagnosis is frequently delayed. Common symptoms and signs are local swelling and a discharging sinus tract. Patients frequently have at least one systemic symptom, including fever, weight loss and night sweats. Our case and half of those found in the literature review were successfully treated with antituberculous drugs alone. Conclusion: Treatment concepts for primary sternal tuberculosis are not established and are often derived from those of osteoarticular tuberculosis. These data point towards an interdisciplinary concept without surgery.