Chest Wall Abscess with Bone Invasion in Infant after BCG Vaccination

The bacillus Calmette-Guérin (BCG) vaccine is a safe live vaccine mainly administered to infants to prevent tuberculosis; complications rarely occur after administration of the BCG vaccine. Herein, we report the case of an infant who developed a rare complication of a tuberculous abscess in the chest wall and osteomyelitis in the ribs after administration of the BCG vaccine at 1 month of age. An 11-month-old male infant was admitted to the hospital due to a palpable mass in the right anterolateral chest area detected about a month before hospitalization, with no tenderness, erythema, or lymphadenopathy. After thoracic computed tomography and ultrasonography, the cause of the abscess was suspected to be mycobacterial infection and the abscess was removed under general anesthesia. Chronic granulomatous inflammation with caseous necrosis was detected through a biopsy, and polymerase chain reaction was performed and <i>Mycobacterium tuberculosis</i> complex was detected. However, staining for acid-fast bacteria and microbiological cultures were negative. Based on these results, the patient was diagnosed with a tuberculous abscess and osteomyelitis in the chest wall owing to administration of the BCG vaccine. After being medicated with isoniazid and rifampicin for 6 months, the patient was successfully treated.

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Chest Wall Mass in Infancy: The Presentation of Bone-Tumor-Like BCG Osteitis

Case Reports in Pediatrics ◽

10.1155/2020/8884770 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Phumin Chaweephisal ◽

Teesit Torchareon ◽

Shanop Shuangshoti ◽

Piti Techavichit

Keyword(s):

Chest Wall ◽

Bone Tumor ◽

Osteolytic Lesion ◽

Granulomatous Inflammation ◽

Mycobacterial Infection ◽

Benign Tumors ◽

Costal Margin ◽

The Right ◽

Wall Mass ◽

Chest Wall Mass

Chest wall mass in infancy is rare. Malignant lesions are more common than infection or benign tumors. This is a case of a 12-month-old girl who presented with a 2 cm mass at the right costal margin and poor weight gain. Chest radiograph demonstrated a moth-eaten osteolytic lesion at the 8th rib. The resection was performed, and a mass with pus content was found. The positive acid fast stain (AFB) organism was noted. Pathology confirmed caseous granulomatous inflammation compatible with mycobacterial infection. However, QuantiFERON-TB Gold was negative, so Mycobacterium bovis (M. bovis) osteitis is highly suspected. She was treated with antimycobacterium drugs and showed good results. Osteomyelitis can manifest by mimicking bone tumors. Without a biopsy, the pathogen may go undetected. So, interventions such as biopsy are warranted and avoid mass resection without indication. High C-reactive protein (CRP), alkaline phosphatase (ALP), periosteal reaction of radiating spicules, and penumbra sign in magnetic resonance imaging (MRI) are helpful for discriminating osteomyelitis from bone tumor.

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Otogenic Anterior Chest Wall Abscess: A Rare and Unique Presentation of Bezold's Abscess

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1061 ◽

2011 ◽

Vol 3 (2) ◽

pp. 90-92 ◽

Cited By ~ 1

Author(s):

Arti Agrawal ◽

Hitendra Prakash Singh ◽

Dharmendra Kumar

Keyword(s):

Differential Diagnosis ◽

Chest Wall ◽

Rare Complication ◽

Anterior Chest Wall ◽

Acute Mastoiditis ◽

Common Cause ◽

Neck Abscess ◽

Chest Wall Abscess ◽

Deep Neck Abscess ◽

Upper Thoracic

ABSTRACT In the era of antibiotics, deep neck abscess is a rare complication of acute mastoiditis. Bezold's abscess, the most common cause of the otogenic deep neck abscess in preantibiotic era, is a rare complication of mastoiditis nowadays and it should be considered in the differential diagnosis of neck abscesses as well as unexplained intracranial/extracranial or upper thoracic abscesses. We report a case of 20-year old female with an abscess over anterior chest wall as a sequele of bezold's abscess which was a complication of cholesteatoma with mastoiditis.

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Sternoclavicular joint septic arthritis presenting as cervical abscess and subcutaneous emphysema: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20902874 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2090287

Author(s):

Brandon E Fornwalt ◽

Madeline Goosmann ◽

Stephen Reynolds ◽

Jared D Bunevich

Keyword(s):

Case Report ◽

Septic Arthritis ◽

Bacterial Infection ◽

Chest Wall ◽

Subcutaneous Emphysema ◽

English Literature ◽

Rare Complication ◽

Sternoclavicular Joint ◽

Hematogenous Spread ◽

Chest Wall Abscess

Sternoclavicular joint septic arthritis results from hematogenous spread of a bacterial infection, usually in the immunocompromised. It commonly presents as a chest wall abscess. Cervical abscess resulting from sternoclavicular joint septic arthritis is a rare complication with only one reported case in the English literature. We describe a case of sternoclavicular joint septic arthritis in an elderly diabetic adult with cervical abscess as initial presentation.

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Large chest wall abscess due to microaerophilic streptococcus

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(02)00091-x ◽

2002 ◽

Vol 21 (5) ◽

pp. 925 ◽

Cited By ~ 1

Author(s):

N Nakano

Keyword(s):

Chest Wall ◽

Chest Wall Abscess

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Primary Tubercular Chest Wall Abscess in a Young Immunocompetent Male

Case Reports in Pulmonology ◽

10.1155/2014/357456 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Shweta Sharma ◽

R. K. Mahajan ◽

V. P. Myneedu ◽

B. B. Sharma ◽

Nandini Duggal

Keyword(s):

Chest Wall ◽

Immunocompetent Patient ◽

Rare Entity ◽

Hematogenous Spread ◽

Clinical Challenge ◽

Chest Wall Abscess ◽

Direct Inoculation ◽

Underlying Pathology ◽

Patient Infection ◽

Rule Out

Chest wall tuberculosis is a rare entity especially in an immunocompetent patient. Infection may result from direct inoculation of the organisms or hematogenous spread from some underlying pathology. Infected lymph nodes may also transfer the bacilli through lymphatic route. Chest wall tuberculosis may resemble a pyogenic abscess or tumour and entertaining the possibility of tubercular etiology remains a clinical challenge unless there are compelling reasons of suspicion. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. We present here a case of chest wall tuberculosis where infection was localized to skin only and, in the absence of any evidence of specific site, it appears to be a case of primary involvement.

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Comparison of Polymerase Chain Reaction With Histopathologic Features for Diagnosis of Tuberculosis in Formalin-Fixed, Paraffin-Embedded Histologic Specimens

Archives of Pathology & Laboratory Medicine ◽

10.5858/2003-127-0326-copcrw ◽

2003 ◽

Vol 127 (3) ◽

pp. 326-330 ◽

Cited By ~ 3

Author(s):

Do Youn Park ◽

Jee Yeon Kim ◽

Kyung Un Choi ◽

Jin Sook Lee ◽

Chang Hun Lee ◽

...

Keyword(s):

Chronic Inflammation ◽

Granulomatous Inflammation ◽

Giant Cells ◽

Caseous Necrosis ◽

Formalin Fixed Paraffin ◽

Formalin Fixed Paraffin Embedded ◽

Type Giant ◽

Tb Pcr ◽

Formalin Fixed ◽

Histopathologic Features

Abstract Objective.—To investigate the relationship between various histopathologic features and the results of the tuberculosis (TB)–polymerase chain reaction (PCR) method in routinely submitted histologic specimens for the histopathologic diagnosis of TB. Design.—We used 95 formalin-fixed, paraffin-embedded tissue blocks from 81 patients who were clinically suspected of having TB. We assessed the presence of histopathologic features including well-formed granuloma, poorly formed granuloma, caseous necrosis, and Langhans-type giant cells. We performed nested PCR for IS6110 and Ziehl-Neelsen staining for acid-fast bacilli (AFB). Results.—Of the 81 patients studied, 53 patients had chronic granulomatous inflammation, whereas 28 patients had only chronic inflammation without definite granulomatous inflammation. Of the 53 cases with chronic granulomatous inflammation, 17 (32%) were AFB positive and 36 (68%) were TB-PCR positive. Among cases with chronic granulomatous inflammation, the percentage that were positive and negative by TB-PCR differed significantly with the presence of various histopathologic features. All of the 13 cases with well-formed granuloma, caseous necrosis, and Langhans-type giant cells were TB-PCR positive; however, 10 (36%) of the 28 cases with chronic inflammation without granulomatous lesions were also TB-PCR positive. Conclusions.—TB-PCR is a rapid, sensitive method for the diagnosis of TB in routinely processed formalin-fixed, paraffin-embedded histologic specimens and is readily available in histopathology laboratories. We recommend use of TB-PCR when TB is suspected clinically, especially in cases of chronic inflammation without definite evidence of granulomatous inflammation.

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