Chest wall tuberculosis in an infant : a rare case report.

Background: Tuberculosis is still an important world health problem. The parietal chest wall site in children is a extremely rare form of tuberculosis. Its diagnosis is often so difficult requiring a surgical biopsy. Case presentation : We report the case of 1.5-year-old infant, with no family history of active tuberculosis, who had a swelling of the anterior chest wall for two months. Physical examination found a swelling measuring 1.5 cm by 1 cm in relation to the second parasternal intercostal space, fluctuating in its center, with an inflammatory skin which fistulized giving a bud-like appearance with a purulent exudate. Chest X-ray was normal. The thoracic computed tomography showed a sternal mass responsible for a bone lysis with an infiltration. Pathology examination of biopsies of the parietal mass confirmed the diagnosis of caseo-follicular tuberculosis with lesion of tuberculosis osteitis. Human immunodeficiency virus serology was negative, early morning gastric aspirates performed on two consecutive days were negative for acid-fast bacilli, and quantiferon TB Gold in tube test resulted was also negative. Antitubercular therapy was started with prolonged regimens for 12 months. She has allowed a favorable outcome with healing of the thoracic parietal lesion after 6 months. Conclusions : Diagnosis of chest well tuberculosis is still challenging even if we are in endemic area and it must be conducted early, his management is based on both surgey and antitubercular therapy for having a complete recovery. Prompt diagnosis and treatment are important to prevent serious complications.