Chest wall tuberculosis in an adolescent: A case report

Chest wall tuberculosis is a rare form of extrapulmonary tuberculosis which comes with a diagnostic and therapeutic challenge. We present a case of a 15-year-old who came with a chief complaint of a palpable lump on the right side of his chest in the last two months before admission. CT scan revealed anterior mediastinal mass on the right side, measuring 2x2.5x5.3 cm, with multiple subpleural nodules in the right hemithorax, and destruction of the 7^th and the 8^th right ribs accompanied by necrotic soft tissue masses, destruction of the 7^th right posterior costae accompanied by a bulging soft tissue mass in the paravertebral body of the 7^th-8^th right costaes, and suspected lymphadenopathy on the left peribronchial, subcarinal, right mid-paratracheal, right lower paratracheal, left lower paratracheal, and right supraclavicular. Fine needle aspiration biopsy revealed histiocyte cells, epithelioid debris, and necrotic lymphocytic inflammation, with Ziehl–Neelsen staining positive for acid-fast bacilli and granulomatous inflammation indicative of tuberculosis. The result of the Xpert MTB/RIF assay from the tissue samples by Fine-Needle Aspiration revealed low-detected Mycobacterium tuberculosis and sensitive to rifampicin. Based on history-taking, clinical manifestation, and physical examination, we assessed this patient as having peripheral tuberculous lymphadenitis, destruction of the 7^th-8^th ribs in the right chest, moderate malnutrition, and complete immunization status. Intensive phase anti-tuberculosis therapy was given and the patient was planned for wide excision chest wall surgery and rib resection surgery.