A Rare Case Of Isolated Sternal Tuberculosis Revealing A Dumbbell-Shaped Cold Abscess

Abstract

Sternal tuberculosis (TB), a rare form of musculoskeletal TB, poses notable challenges in both diagnosis and treatment due to its uncommon occurrence along with nonspecific symptoms. This review consolidates current knowledge on sternal TB, covering its epidemiology, clinical manifestations, diagnostic techniques, and management strategies. Sternal TB usually results from hematogenous dissemination or direct spread from adjacent infections. Patients often present with localized pain, swelling, and fluctuant masses, which can be mistaken for pyogenic osteomyelitis or malignancies. Systemic symptoms like fever and weight loss are inconsistently observed. Imaging techniques such as X-ray, CT, and MRI typically reveal osteolytic lesions, periosteal reactions, or abscesses, while definitive diagnosis relies on histopathology and nucleic acid amplification tests like PCR. The primary treatment involves a 9–12 month regimen of multidrug antitubercular therapy (ATT), with surgical intervention—such as debridement or abscess drainage—considered in cases of extensive bone damage or inadequate response to medical therapy. Due to the vague clinical presentation, delayed diagnosis is common and may lead to complications like fistula formation, deformities, or secondary infections. A strong clinical suspicion is crucial, especially in endemic areas where tuberculosis is common or in immunocompromised patients. This review highlights the importance of an interdisciplinary approach to improve outcomes in this rare but potentially debilitating condition