Vol. 7, Issue 1, Part A (2025)

Introduction: In Western countries, the incidence of pulmonary tuberculosis is declining, while extra-pulmonary tuberculosis has increased. Health care providers in Somalia are concerned about the increase in both forms. Tuberculosis, defined as a cold abscess of the anterior chest wall without involvement of adjoining structures like the sternum, ribs, pleura, and lung in an adult healthy, immune-competent male, is presented due to its uncommon occurrence and fewer reports.
Case Report: We did not suspect tuberculosis when a 28-year-old man with no significant medical history presented with a 5 x 2 centimeter swelling over his chest wall. We performed fine needle aspiration to obtain a sample for bacterial culture and initiated empirical antibiotic therapy. Despite antibiotic treatment, the swelling persisted. After cutting the wound and draining it, a lot of pus came out. gene xpert testing showed a very low level of Mycobacterium tuberculosis (TB). He was non-reactive for anti-HIV; the patient had no known TB exposure or risk factors. We started a course of anti-tuberculosis medication category I. After one month of treatment, the wound had completely healed.
Conclusion: In developing countries like Somalia, where PTB is endemic and a major public health problem, EPTB is not rare. However, a cold abscess resulting from M. tuberculosis in the anterior chest wall, without the involvement of any adjacent structures, is relatively rare. Regardless of socioeconomic status, chest physicians and surgeons should evaluate all sternal masses in patients from developing countries for tuberculosis, including biopsy, AFB smear, and culture.