Tubercular Costochondritis Presenting as Chest Wall Swelling: A Case Report of an Atypical Tuberculosis Presentation

Costochondritis is an inflammatory condition of the costochondral junctions, rarely due to tuberculosis (TB). One-quarter of the world's population is affected by tuberculosis, while musculoskeletal tuberculosis accounts for only 1-2% of the total cases. Among these cases, the involvement of the ribs is extremely rare. The following case report describes a 60-year-old male with diabetes who had recurrent thoracic wall swelling with greenish discharge for 23 years, misdiagnosed and treated as sebaceous cysts. Recently, at its exacerbation, imaging and biopsy revealed tubercular costochondritis, a very rare form of extrapulmonary tuberculosis that affects the ribs. Antituberculous therapy administered for nine months showed complete resolution of symptoms. This case underscores the key issue of placing tuberculosis within the differential diagnosis for a chest wall swelling, highlighting its diagnostic challenge in this atypical presentation. Advanced imaging and histological examination were of importance in coming up with an accurate diagnosis; hence, clinical suspicion needs to be increased and more research done in the light of management guidelines for this rare condition.