Breast Abscess or Deeper Problem; A Unique Diagnostic Mystery of Sternal TB

Introduction:Sternal tuberculosis represents an extremely rare form of extrapulmonary tuberculosis that physicians typically misdiagnose because its clinical signs match common conditions such as breast abscesses.Early detection of sternum tuberculosis proves difficult because this form of osteoarticular tuberculosis represents fewer than 1% of cases among patients who are young and immunocompetent and lack identified risk factors.Case presentation: A 16-year-old female without tuberculosis history presented with a right parasternal mass along with low-grade fever and weight loss and malaise.The patient received a breast ultrasound diagnosis that indicated a breast abscess so medical staff began antibiotic treatment.The patient showed temporary improvement in general health indicators although the mass failed to disappear.The follow-up imaging revealed a hypoechoic lesion containing internal debris and cortical irregularity located at the sternum.CT imaging revealed both lytic and sclerotic changes in the lower portion of the sternum along with a cold abscess that penetrated into the right parasternal soft tissues.The pathologist confirmed the diagnosis of sternal tuberculosis after performing histopathological tests on tissue samples obtained after surgical debridement.The patient received standard four-drug anti-tubercular therapy afterwards consisting of isoniazid, rifampicin, pyrazinamide and ethambutol which led to the complete healing of clinical symptoms along with imaging results. Conclusion:The case presentation demonstrates the necessity of treating atypical infections like sternal tuberculosis by being alert to its potential when dealing with unresolving chest wall lesions.Imaging tools including ultrasound and CT provide important diagnostic assistance when used at the beginning of the process.In regions with endemic TB cases patients without standard risk factors who are immunocompetent may develop unusual forms of TB.Immediate administration of anti-tubercular treatment produces exceptional treatment results that eliminate the need for complex surgical operations.