Multiple sinuses and induration of chest wall is likely due to: (A) Tuberculosis, (B) Atypical mycobacterial infection, (C) HIV-AIDS patient with tuberculosis, (D) Pulmonary actinomycosis
Answer is D. Pulmonary Actinomycosis. Lung and pleura get infected by direct spread from pharynx or by aspiration. Empyema develops. Later chest wall nodules appear leading to sinuses with discharge(20%). Fascio-cervical type is the most common Reference : SRB's Manual of Surgery, 6th Edition, page no = 54.