title: Primary sternal tuberculous ulcer with dissemination to the bone marrow: a clinical rarity.
abstract: Primary tubercular osteomyelitis of the sternum with dissemination to bone marrow is a rarely described entity even in countries where tuberculosis is endemic. Delayed presentations can be in the form of sinus formation, spontaneous fracture of the sternum, extrasternal spread, and sepsis. Diagnosis can be made by CT of the chest wall and Ziehl-Neelsen staining of aspirate from the lesion or by tissue biopsy. We present a case of tuberculous osteomyelitis of the sternum with sinus formation along with widespread involvement of bone marrow, which was successfully treated with antituberculous therapy. Sternal osteomyelitis is difficult to diagnose on chest radiography and ultrasonography, but we were able to make the probable diagnosis of sternal tuberculous osteomyelitis. CT showed erosion of part of the sternal bone. Diagnosis was confirmed on histopathology and by bone marrow trephine biopsy. During the follow-up period of 3 months, the patient showed a satisfactory response to treatment.
authors.affiliation: Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana Ambala, Haryana, India.
authors.forename: Rikki
authors.initials: R
authors.lastname: Singal
authors.forename: Prem
authors.initials: P
authors.lastname: Singh
authors.forename: Amit
authors.initials: A
authors.lastname: Mittal
authors.forename: Samita
authors.initials: S
authors.lastname: Gupta
authors.forename: Shveta
authors.initials: S
authors.lastname: Singla
authors.forename: Deepesh Benjamin
authors.initials: DB
authors.lastname: Kenwar
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000382:microbiology* / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013249:Sternum / Q000382:microbiology / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents