Publication

Abstract : A 72-year-old man presented with upper back pain for 1 month and swelling over the sternum of 4 days’ duration. He had no constitutional symptoms. One year earlier he had undergone coronary artery bypass surgery with an uneventful postoperative recovery. Clinical examination revealed a fluctuant swelling over the body of the sternum. There was mild tenderness but no erythema. Radiography of the chest and thoracic spine showed normal results (Figure 1). He had a total white blood cell count of 10,000/mm,3 with a differential count of 68% neutrophils and 30% lymphocytes, and an erythrocyte sedimentation rate of 105 mm/hour. Drainage of sternal abscess and removal of underlying possibly infected sternal wires were performed. Intraoperatively, a large abscess cavity (3.5 × 3 cm) was detected in the body of the sternum unrelated to the sternal wires. The cavity was lined with infected granulation tissue extending to the inner table of the sternum. The granulation tissue was curetted until healthy bleeding bony surface was observed. The pectoralis major muscle was mobilized to cover the defect, and the wound was closed in layers over a suction drain. The patient had an uneventful postoperative recovery and was relieved of back pain. The curetted tissue was sent for histopathology and bacterial culture. Histology revealed a caseating granulomatous lesion with sequestrum formation consistent with tuberculous osteomyelitis (Figure 2); the routine culture was negative, whereas BACTEC culture revealed mycobacterium tuberculosis (TB). On a 4-drug antituberculous regimen, the patient is doing well at 6 months.