A Case of Tuberculous Osteomyelitis of the Sternum with Discharging Sinus in an Indian Girl

Pediatric tuberculosis (TB) includes asymptomatic primary infection, progressive pulmonary TB and extra-pulmonary disease. Skeletal TB occurs in 1-6% of the extra-pulmonary cases commonly involving spine (50-65%), hip and knee joints[1]. Primary TB involving sternum is uncommon often causing a delay in clinical suspicion and diagnosis[2,3]. We report a 5 year-old with primary sternal tuberculous osteomyelitis presenting late with discharging sinus. A 5-year-old girl from poor socio-economic status presented with increasing dull-aching pain and discharge from a non-traumatic ulceration on the anterior chest wall over the body of sternum for the last 3 months along with low grade fever and reduced appetite. She had been previously treated as pyogenic osteomyelitis but the swelling progressed to ulcerate. She had contact with her neighbor having sputum positive pulmonary TB on anti-tubercular drugs for the last 4 months. Examination revealed her weight (12 kg) and height (117 cm) were both below 5th centiles. In the upper third of the body of the sternum, there was a tender, discharging ulcer 7cm × 9 cm, surrounded by indurated, erythematous skin with serous, odorless discharge oozing from its sinus which extended up to the bone (Fig. 1). Other than mild pallor, her clinical examination was unremarkable. Scar of BCG vaccination was present. Her hemogram showed hemoglobin 8.7 mg/dL (microcytic, hypochromic anemia) with total leukocyte count of 10,000/cu mm and differential of 72% lymphocytes. ESR was 80 mm in 1st hour. Fig.1: Discharging ulcer 7cm × 9 cm, surrounded by indurated, erythematous skin with oozing serous discharge in the upper part of body of the sternum