title: Destructive rib lesions in an HIV sero-negative male: an unusual presentation of tuberculosis in a high tuberculosis prevalence setting.
abstract: Tuberculosis (TB) of the rib is a very rare form of skeletal TB and its diagnosis may be difficult because of a low index of suspicion by clinicians. The presentation often mimics malignant disease clinically and radiologically and diagnosis may only be confirmed by tissue biopsy. We present a 32-year-old HIV-negative man who presented with a three-month history of progressively worsening pleuritic chest pain, weight loss, fatigue, anorexia and low-grade fever with night sweats. A chest computerized tomography (CT) scan showed destructive lesions in the right fourth and seventh ribs with no pulmonary lesions. A diagnosis of TB of the rib was made after surgical resection and histopathology of the affected tissue. There was significant improvement when anti-TB therapy was initiated. This case report emphasizes the importance of a high index of suspicion of TB in patients presenting with destructive bone lesions in regions with high prevalence of TB.
authors.affiliation: Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. lydikiyingi@yahoo.com
authors.forename: Lydia
authors.initials: L
authors.lastname: Nakiyingi
authors.forename: John M
authors.initials: JM
authors.lastname: Bwanika
authors.forename: Robert
authors.initials: R
authors.lastname: Lukande
authors.forename: Bruce
authors.initials: B
authors.lastname: Kirenga
authors.forename: Tom P
authors.initials: TP
authors.lastname: Mwambu
authors.forename: William
authors.initials: W
authors.lastname: Worodria
authors.forename: Martin
authors.initials: M
authors.lastname: Okot-Nwang
mesh_terms: D000328:Adult; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D012272:Ribs / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014394:Tuberculosis, Osteoarticular / Q000000981:diagnostic imaging / Q000473:pathology*