Pulmonary and mediastinal tuberculosis in an immunocompetent child presenting as sternal abscess protruding from the skin

Excerpt

A 10.5-year-old otherwise healthy male patient, coming from Somalia, admitted to our centre because of a swelling lesion on his chest over the sternum. The abscess had slowly grown over a period of 2 months. He had not have cough, fever and weight loss. There was a 4 × 4 cm sized fluctuating abscess on the skin over sternum in physical examination (Fig. 1). Bacille Calmette-Guérin (BCG) scar was positive on his left shoulder. Infection markers were negative. Contrast-enhanced computed tomography (CT) had showed subcarinal 43 × 30 mm sized with central necrosis in the middle of lesion, multiple mediastinal and hilar lymphadenopathies, 60 × 40 mm sized abscess close to arcus aorta that destructed of sternum and reached out to subcutaneous tissue and centrilobular nodules and tree-in-bud sign in upper lobe of right lung. He was hospitalized and diagnosed with pulmonary and mediastinal lymph node tuberculosis. Spontaneous drainage of abscess occured. As an acid-fast bacilli, polymerase chain reaction (PCR) and culture for Mycobacterium tuberculosis complex were positive in abscess material, a diagnosis of pulmonary and mediastinal TB was made and oral anti-TB therapy was started. Subtype analysis of material was compatible with Mycobacterium tuberculosis. Immune deficiency and HIV serology were negative. Swelling lesion was resolved completely on the third week of therapy (Fig. 2).

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