1887

JMM Case Reports

Volume 1, Issue 2

Primary sternal tuberculosis: a case report and review of the literature Open Access

Abstract

Introduction:

Primary sternal osteomyelitis caused by 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 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.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): sternal osteomyelitis , TB medication and tuberculosis
© 2014 The Authors
  • This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/).
Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.002063
2014-06-01
2024-04-24
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/1/2/jmmcr002063.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.002063&mimeType=html&fmt=ahah

References

  1. Ali W.M., Beg M.H., Rashid M., Zafar U., Abbas S.N. ( 2008). An experience with a rare diagnosis of isolated tuberculosis of sternum at JNMC Hospital, Aligarh, India. Saudi Med J 29:580–583
     [Google Scholar]
  2. Ashour M., Pandya L. ( 1990). Tuberculosis of the sternum. Ann Saudi Med 10:57–59
     [Google Scholar]
  3. Bajracharya S., Singh G., Singh M. ( 2006). Primary tubercular osteomyelitis of the sternum: report of two cases. Internet J Third World Med 5:
     [Google Scholar]
  4. Bandyopadhyay S.K., Moulick A., Ghosal J., Dutta A. ( 2005). Presternal cold abscess. J Assoc Physicians India 53:866
     [Google Scholar]
  5. Barbetakis N., Asteriou C., Kleontas A., Karvelas C. ( 2011). Primary sternal tuberculosis mimicking anterior chest wall tumor: case report. Tuberk Toraks 59:164–167 [CrossRef]
     [Google Scholar]
  6. Bhatia V.Y., Aggarwal V., Sharma U., Gupta A. ( 2009). Primary tuberculous sternal osteomyelitis: a clinical rarity. Asian Cardiovasc Thorac Ann 17:310–312 [CrossRef]
     [Google Scholar]
  7. Blumberg H.M., Burman W.J., Chaisson R.E., Daley C.L., Etkind S.C., Friedman L.N., Fujiwara P., Grzemska M., Hopewell P.C. other authors( 2003). American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 167:603–662 [CrossRef]
     [Google Scholar]
  8. Boorugu H.K., Chrispal A., Thomas E.M. ( 2009). Sternal tuberculous osteomyelitis presenting as a pulsatile swelling. Indian J Tuberc 56:154–156
     [Google Scholar]
  9. CDC( 2013). Reported Tuberculosis in the United States, 2012. Atlanta, GA: US Department of Health and Human Services;
     [Google Scholar]
  10. Davies P.D., Humphries M.J., Byfield S.P., Nunn A.J., Darbyshire J.H., Citron K.M., Fox W. ( 1984). Bone and joint tuberculosis. A survey of notifications in England and Wales. J Bone Joint Surg Br 66:326–330
     [Google Scholar]
  11. de Carli D.M., Severo M.D., Haygert C.J., Guollo M., Omairi A., Pedro V.D., Silva E.P., Rodrigues A.T. ( 2009). Sternal osteomyelitis caused by infection with Mycobacterium tuberculosis . J Bras Pneumol 35:709–712 [CrossRef]
     [Google Scholar]
  12. Dhingra V.K., Rajpal S., Gupta U.A., Aggarwal J.K., Mandal A.K., Chowdhury V. ( 2005). A young man with midline swelling over the front of chest. Indian J Tuberc 52:93–98
     [Google Scholar]
  13. Enarson D.A., Fujii M., Nakielna E.M., Grzybowski S. ( 1979). Bone and joint tuberculosis: a continuing problem. Can Med Assoc J 120:139–145
     [Google Scholar]
  14. Ford S.J., Rathinam S., King J.E., Vaughan R. ( 2005). Tuberculous osteomyelitis of the sternum: successful management with debridement and vacuum assisted closure. Eur J Cardiothorac Surg 28:645–647 [CrossRef]
     [Google Scholar]
  15. Gatfosse M., Zellner P., Barjonet G. ( 1995). Tuberculosis of the sternum. Report of a case. Rev Rhum Engl Ed 62:152–153
     [Google Scholar]
  16. Gupta R., Gupta A., Gupta K.B., Sood S. ( 2009). Sternal tuberculosis and gynecomastia. J Postgrad Med 55:276–277 [CrossRef]
     [Google Scholar]
  17. Hsu H.S., Wang L.S., Wu Y.C., Fahn H.J., Huang M.H. ( 1995). Management of primary chest wall tuberculosis. Scand J Thorac Cardiovasc Surg 29:119–123 [CrossRef]
     [Google Scholar]
  18. Jain V.K., Singh Y., Shukla A., Mittal D. ( 2007). Tuberculous osteomyelitis of sternum: A case report. J Clin Diagn Res 1:163–167
     [Google Scholar]
  19. Jambhekar N.A., Kulkarni S.P., Madur B.P., Agarwal S., Rajan M.G. ( 2006). Application of the polymerase chain reaction on formalin‐fixed, paraffin‐embedded tissue in the recognition of tuberculous osteomyelitis. J Bone Joint Surg Br 88:1097–1101 [CrossRef]
     [Google Scholar]
  20. Joint Tuberculsosis Committee of the British Thoracic Society( 1998). Chemotherapy and management of tuberculosis in the United Kingdom: recommendations. Thorax 53:536–548 [CrossRef]
     [Google Scholar]
  21. Khaira A., Khaira D.D., Gupta A., Bhowmik D., Kalra O.P., Tiwari S.C. ( 2009). Tuberculosis of sternum: three cases with different presentations. J Assoc Physicians India 57:595–596
     [Google Scholar]
  22. Khan S.A., Varshney M.K., Hasan A.S., Kumar A., Trikha V. ( 2007). Tuberculosis of the sternum: a clinical study. J Bone Joint Surg Br 89:817–820 [CrossRef]
     [Google Scholar]
  23. Kim Y.T., Han K.N., Kang C.H., Sung S.W., Kim J.H. ( 2008). Complete resection is mandatory for tubercular cold abscess of the chest wall. Ann Thorac Surg 85:273–277 [CrossRef]
     [Google Scholar]
  24. McLellan D.G., Philips K.B., Corbett C.E., Bronze M.S. ( 2000). Sternal osteomyelitis caused by Mycobacterium tuberculosis: case report and review of the literature. Am J Med Sci 319:250–254 [CrossRef]
     [Google Scholar]
  25. Medical Research Council Working Party on Tuberculosis of the Spine( 1986). A controlled trial of six‐month and nine‐month regimens of chemotherapy in patients undergoing radical surgery for tuberculosis of the spine in Hong Kong. Tenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. Tubercle 67:243–259 [CrossRef]
     [Google Scholar]
  26. Medical Research Council Working Party on Tuberculosis of the Spine( 1999). Five‐year assessment of controlled trials of short‐course chemotherapy regimens of 6, 9 or 18 months’ duration for spinal tuberculosis in patients ambulatory from the start or undergoing radical surgery. Fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. Int Orthop 23:73–81 [CrossRef]
     [Google Scholar]
  27. Mineo T.C., Biancari F. ( 1995). Sternal mass and fever. Postgrad Med J 71:569–571 [CrossRef]
     [Google Scholar]
  28. Mohammadi A., Howell J.M. ( 2009). Sternal tuberculosis. J Emerg Med 36:342–344 [CrossRef]
     [Google Scholar]
  29. Mulloy E.M. ( 1995). Tuberculosis of the sternum presenting as metastatic disease. Thorax 50:1223–1224 [CrossRef]
     [Google Scholar]
  30. Peto H.M., Pratt R.H., Harrington T.A., Lobue P.A., Armstrong L.R. ( 2009). Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin Infect Dis 49:1350–1357 [CrossRef]
     [Google Scholar]
  31. Prakash A., Hira H.S. ( 2000). Tuberculous osteomyelitis of sternum in a diabetic. Indian Journal of Tuberculosis 48:35–36
     [Google Scholar]
  32. Rasaretnam R., Wijesekera C., Wickramasekera D. ( 1997). Sternal osteomyelitis. Ceylon Med J 42:198–199
     [Google Scholar]
  33. Saifudheen K., Anoop T.M., Mini P.N., Ramachandran M., Jabbar P.K., Jayaprakash R. ( 2010). Primary tubercular osteomyelitis of the sternum. Int J Infect Dis 14:e164–e166 [CrossRef]
     [Google Scholar]
  34. Sendi P., Friedl A., Graber P., Zimmerli W. ( 2008). Reactivation of dormant microorganisms following a trauma. Pneumonia, sternal abscess and calcaneus osteomyelitis due to Mycobacterium tuberculosis . Neth J Med 66:363–364
     [Google Scholar]
  35. Singal R., Singh P., Mittal A., Gupta S., Singla S., Kenwar D.B. ( 2011). Primary sternal tuberculous ulcer with dissemination to the bone marrow: a clinical rarity. Ann Saudi Med 31:542–545 [CrossRef]
     [Google Scholar]
  36. Singh S., Nagaraj C., Khare G.N., Kumaraswamy V. ( 2011). Multicentric tuberculosis at two rare sites in an immunocompetent adult. J Orthop Traumatol 12:223–225 [CrossRef]
     [Google Scholar]
  37. Subba Rao K.S.V.K., Gupta B.K., Ramakrishnan K. ( 1982). Tuberculous osteomyelitis of the sternum. Indian J Tuberc 29:244–246
     [Google Scholar]
  38. Vasa M., Ohikhuare C., Brickner L. ( 2009). Primary sternal tuberculosis osteomyelitis: a case report and discussion. Can J Infect Dis Med Microbiol 20:e181–e184
     [Google Scholar]
  39. Vyravanathan S., Nadarajah N. ( 1981). Tuberculosis of the skin over the sternum. Jaffna Med J 16:23–28
     [Google Scholar]
  40. Wang T.K., Wong C.F., Au W.K., Cheng V.C., Wong S.S. ( 2007). Mycobacterium tuberculosis sternal wound infection after open heart surgery: a case report and review of the literature. Diagn Microbiol Infect Dis 58:245–249 [CrossRef]
     [Google Scholar]
  41. Watts H.G., Lifeso R.M. ( 1996). Tuberculosis of bones and joints. J Bone Joint Surg Am 78:288–298
     [Google Scholar]
  42. Watts R.A., Paice E.W., White A.G. ( 1987). Spontaneous fracture of the sternum and sternal tuberculosis. Thorax 42:984–985 [CrossRef]
     [Google Scholar]
  43. WHO( 2009). Treatment of tuberculosis: guidelines, 4th edn. http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf Geneva: World Health Organization;
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.002063
Loading
Primary sternal tuberculosis: a case report and review of the literature
JMM Case Rep 1, e002063 (2014); https://doi.org/10.1099/jmmcr.0.002063
/content/journal/jmmcr/10.1099/jmmcr.0.002063
/content/journal/jmmcr/10.1099/jmmcr.0.002063
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error