Article, Emergency Medicine

Tuberculous sternal osteomyelitis

Unlabelled imageCase Report

Contents lists available at ScienceDirect

American Journal of Emergency Medicine

journal homepage: locate/ ajem

Tuberculous sternal osteomyelitis

Abstract

A 32-year-old female patient with systemic lupus erythematosus presented with 1 month of nocturnal subjective fevers, night sweats, poor appetite, malaise, 8-kg weight loss, and a 6-cm painful sternal mass. She had normal vital signs with a physical examination notable only for the presence of a fluctuating sternal mass. A computed tomographic scan of the thorax showed a 67 x 32 x 27-mm sternal mass associated with severe sternal osteomyelitis (Fig. 1); then a surgical drainage was performed, and abundant caseous material was removed, leaving a Penrose drain (Fig. 2). Histologic exami- nation of the bone tissue revealed extensive necrosis and granulomas with multinucleated giant cells. The bone, secretion, and soft tissue were negative for acid-fast bacillae on Ziehl-Neelsen stain; but culture grew Mycobacterioum tuberculosis, and she was started on 4 first-line antituberculosis medications, showing rapid Symptomatic improvement, and was discharged 4 weeks after admission (Fig. 3).

A 32-year-old female patient with systemic lupus erythemato- sus, who has been taking prednisone 15 mg a day since 2012, presented in October 2013 with 1 month of nocturnal subjective fevers, night sweats, 5-kg weight loss, and a 6-cm painful sternal mass. She was started on multiple Empirical antibiotics for presumptive bacterial infection, with no improvement. In Novem- ber 2013, she presented to the local emergency department because

Fig. 2. Post-surgical image with the penrose drain.

Fig. 1. Thorax CT scan showing an sternal mass associated with severe sternal osteomyelitis.

of poor appetite, malaise, 8-kg weight loss, persistent sternal mass, and chest pain. She had normal vital signs, with a physical examination notable only for the presence of a 6-cm sternal mass that was fluctuating on palpation. A computed tomographic scan of the thorax showed retrosternal necrotizing lymphadenopathies with a 67 x 32 x 27-mm sternal mass associated with severe sternal osteomyelitis (Fig. 1); then she was admitted for an open surgical drainage, in which surgeons removed abundant caseous material, leaving a penrose drain (Fig. 2). histologic examination of the bone tissue revealed extensive necrosis and granulomas with multinucleated giant cells. The bone, secretion, and soft tissue were negative for acid-fast bacillae on Ziehl-Neelsen stain; but culture grew Mycobacterioum tuberculosis. The result of a test for human immunodefiency virus was negative; and she was started on 4 first- line antituberculosis medications, showing rapid symptomatic improvement, and was discharged 4 weeks after admission (Fig. 3) [1,2].

0735-6757/(C) 2014

Fig. 3. Clinical appearance after one month of anti-TB treatment.

Juan Carlos Catano, MD

Infectious Diseases Section Internal Medicine Department, University of Antioquia Medical School

Calle 15 Sur # 48-130, Medellin, Colombia E-mail address: [email protected]

Daniela Galeano Juan Camilo, Botero, MD Internal Medicine Department

CES University Medical School, Medellin, Colombia

http://dx.doi.org/10.1016/j.ajem.2014.03.048

References

  1. Vasa M, Ohikhuare C, Bricker L. Primary sternal tuberculosis osteomyelitis: a case report and discussion. Can J Infect Dis Med Microbiol 2009;20(4):e181-4.
  2. Khan SA, Varshney MK, Hasan AS, et al. Tuberculosis of the sternum: a clinical study. J Bone Joint Surg (Br) 2007;89:17-20.

Leave a Reply

Your email address will not be published. Required fields are marked *