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A RARE LOCALIZATION OF TUBERCULOSIS IN IMMUNOCOMPETENT PATIENTS

2023; Elsevier BV; Volume: 164; Issue: 4 Linguagem: Inglês

10.1016/j.chest.2023.07.661

1931-3543

FERIEL SOUISSI, AMINA ABDELKBIR, HAZEM ZRIBI, MAHDI ABDENNADHER, S. Maazaoui, ADEL MARGHLI,

Diagnosis and treatment of tuberculosis

PURPOSE: Chest wall tuberculosis is a rare and uncommon form of extra-pulmonary tuberculosis especially in an immunocompetent patient.Cold abscess and pseudo-tumoral mass constitute its clinical presentations.The diagnosis of this rare entity can be difficult since it mimes parietal tumors and other infectious diseases.Surgery and anti-tuberculosis treatment are the mainstays of treatment. METHODS:We performed a retrospective study over 15 cases of immunocompetent patients who were operated for thoracic parietal tuberculosis at the department of thoracic surgery of Abderrahmane Mami in Ariana, Tunisia over the period from January 2000 to December 2019. RESULTS:The average age was 47 years old [30-80 years old] with a sex ratio M/F of 1,8.Only one patient had pulmonary tuberculosis.In most cases, the onset was insidious and the diagnosis was suspected by the appearance of a soft and painful parietal thoracic swelling with a size ranging from 2 to 2.5 cm.The lesion was fistulized to the skin in 40% of cases.All the signs of tuberculosis impregnation were present except fever.A biological inflammatory syndrome was found in 35% of cases.Imaging guided the diagnosis by showing a subcutaneous collection with opposite osteolysis without endo-thoracic extension in all cases.Multiple cold abscesses were observed in 3 cases.All patients underwent a surgical treatment that consists in a flattening of the cold abscess with biopsy.Anti-tuberculosis treatment was administered in all patients on day 1 postoperatively.The postoperative course was simple with good clinical and radiological evolution in all patients.Diagnostic confirmation was essentially histological.All patients were put on anti-bacillary treatment, with a good radio-clinical evolution.The follow-up period was on average 34 months and no recurrence was noted.CONCLUSIONS: While tuberculosis is frequent in Tunisia, cold tuberculous abscesses remain a rare form of extra-pulmonary tuberculosis.The earlier the treatment is initiated, the more favorable the evolution.The search for other extra-thoracic and thoracic tuberculosis locations is necessary because they condition the therapeutic modalities. CLINICAL IMPLICATIONS: Evoke tuberculosis even in immunocompetent patients