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Case Report: Chest Wall Tuberculosis without Pulmonary Involvement in Three Pediatric Immunocompetent Patients

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  • 1 Service of Infectology, National Institute of Pediatrics (NIP), Mexico City, Mexico;
  • | 2 Medical Direction, National Institute of Pediatrics, Mexico City, Mexico;
  • | 3 Service of Radiology, National Institute of Pediatrics, Mexico City, Mexico;
  • | 4 Pediatric Infectious Diseases, Cafam Clinic, Bogota, Colombia;
  • | 5 Laboratory of Pharmacology, National Institute of Pediatrics, Mexico City, Mexico;
  • | 6 Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico;
  • | 7 Service of Traumatology and Orthopedics, National Institute of Pediatrics, Mexico City, Mexico
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Primary rib cage tuberculosis (TB) is an infrequent form of presentation and represents 1% of all cases of osteoarticular TB. We report three cases of children who were previously healthy and who began with swelling of the anterior surface of the rib as initial manifestation of TB. The most important clinical presentations in this series were swelling and pain, with lytic lesions and a soft tissue mass in image studies simulating oncologic pathologies. Because none of the cases had positive epidemiological contact, TB was initially not considered, so the delay in diagnosis from the onset of symptoms was 4, 1, and 2 months, respectively. The diagnosis was made through histomorphological analyses. Treatment was administered during 12, 10, and 9 months. Posttreatment studies did not show any evidence of extrapulmonary TB and until date, the patients remained without relapse or active disease. The findings in our cases illustrate that the diagnosis of chest wall TB should be suspected in all patients from endemic areas who present rib injury.

Author Notes

Address correspondence to Hugo Juarez Olguin, Laboratorio de Farmacología, Instituto Nacional de Pediatría, Avenida Imán N° 1, 3rd piso Colonia Cuicuilco, Mexico City 04530, Mexico. E-mails: juarezol@yahoo.com or adrianos27@hotmail.com

Disclosure: The study was authorized by the Ethics Committee of National Institute of Pediatrics. All data generated or analyzed during this study are included in this published article. Besides, any additional data/files may be obtained from the corresponding author.

Authors’ addresses: Napoleon González Saldaña, Mercedes Macías Parra, Eduardo Arias de la Garza, Diego Galvis Trujillo, Ana Jocelyn Carmona Vargas, Martin Eduardo Palavicini Rueda, and Jose Ivan Castillo Bejarano, Service of Infectology, Instituto Nacional de Pediatria, Mexico City, Mexico, E-mails: drnagosal@hotmail.com, mermacpar@hotmail.com, lalo_arias@hotmail.com, diego.galvis.trujillo@gmail.com, ajocelinc@hotmail.com, mpalavicinir@hotmail.com, and jicastillobejarano@gmail.com. Sara Solorzano Morales, Service of Radiology, Instituto Nacional de Pediatria, Mexico City, Mexico, E-mail: dra.solorzano@yahoo.com.mx. Hugo Juarez Olguin, Laboratory of Pharmacology, Instituto Nacional de Pediatria, Mexico City, Mexico, E-mail: juarezol@yahoo.com.