A 30 Year Old Man with Fever and Indolent Soft Tissue Masses

Abstract: Problem statement: Multifocal Skeletal Tuberculosis (MSTB) is a rare presentation of skeletal tuberculosis. The indolent nature of this condition often leads to delayed or missed diagnosis, sometimes with devastating consequences for the patient. In order to provide meaningful clinical information and to highlight pitfalls in diagnosis of MFST, we present a case of MSTB. A review of this condition is included for broader coverage. Approach: A 30 year old immune-competent male patient with a 1 year history of indolent soft tissue masses on the chest wall overlying the sternum and the ribs. CAT scan of the chest showed multiple lytic bony lesions involving the ribs, sternum and vertebrae that mimicked metastatic cancer. Fine needle aspiration of the lesion revealed AFB and granulomas. Culture of the aspirated material grew mycobacterium tuberculosis and a diagnosis of MSTB was made. Results: A diagnosis of MSTB was made and anti-tuberculous therapy was initiated. Conclusion: This case indicated that multi-focal skeletal tuberculosis may develop in immune-competent patients without overt pulmonary involvement. From our experience along with previously reported data, MSTB should be suspected in patients from endemic areas who present with multiple skeletal bony lesions. Appropriate management and therapy are essentials for cure and to prevent complications.