Sternal Tuberculosis
A 26-year-old male presented with a primary complaint of swelling and discharge in the upper part of sternum since last 6 months []. There was history of development of discharging sinus and fistula following pus aspiration from swelling. He also complained of intermittent fever, anorexia and weight loss of nearly 7 kg during last 6 months. There was no past history of Koch's. On examination, there was a discharging sinus in upper part of the sternum. Rest general physical and systemic examination was within normal limits. Routine blood investigations-complete blood count, kidney function test, liver function test, random blood sugar and serum electrolytes were within normal limits; hemoglobin was 11 g/dl; erythrocyte sedimentation rate-64 mm/h; Mantoux-15 mm × 15 mm; chest radiograph was normal; patient was non-reactive to HIV test; ultrasound chest revealed two hypoechoic linear tracts communicating with skin; pus aspirate was positive for acid fast bacilli on Ziehl-Neelsen staining; Contrast enhanced computed tomography (CECT) of the thorax [Figures and ] showed peripherally enhancing hypodense collection seen in the subcutaneous plane with underlying irregularity of body of sternum-caries of sternum with few calcified lymph node noticed in paratracheal region; underlying lung parenchyma appeared normal. Patient was counseled and started on anti-tubercular therapy under directly observed therapy short course (DOTS) of alternate day regime prescribed under Revised National Tuberculosis Control Program, i.e., isoniazid (600 mg), rifampicin (450 mg), pyrazinamide (1500 mg) and ethambutol (1200 mg). The patient is under follow up and has improved clinically with afibrile status, weight gain, resolution of pus and healing of sinuses. It is planned to administer intermittent therapy under DOTS for 9 months.