title: Tuberculous osteomyelitis/arthritis of the first costo-clavicular joint and sternum.
abstract: A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.
authors.affiliation: Prasan Patel, Faculty of Medicine, Health Science Centre Foothills Campus, University of Calgary, Calgary AB T2N 4N1, Canada.
authors.forename: Prasan
authors.initials: P
authors.lastname: Patel
authors.affiliation: Prasan Patel, Faculty of Medicine, Health Science Centre Foothills Campus, University of Calgary, Calgary AB T2N 4N1, Canada.
authors.forename: Robin R
authors.initials: RR
authors.lastname: Gray
keywords: Infectious diseases; Medicine in developing countries; Osteomyelitis; Radiology; Sternum; Tuberculosis