Extrapulmonary TB with unusual presentation: A case report

Abstract

Tuberculosis (TBC) is a re-emerging disease with the potential for extrapulmonary involvement in any organ. While multiple sites of extrapulmonary TBC are recognized (lymph node, osteoarticular, meningeal), its presentation in the retropectoral region, especially in the pediatric population without pubertal development, is exceptionally rare. We present the case of a 9-year-old school-aged child, without pubertal changes, who developed a 7 x 8 cm enlargement in the right breast accompanied by intermittent fevers. Initial treatment consisted of antibiotic therapy for 15 days, with a sluggish course, and multiple cultures for bacteria and fungi yielded negative results. The definitive diagnosis of extrapulmonary TB was reached after a positive PPD test and histopathological confirmation of the collection located in the right retropectoral space, without pleural involvement. The patient began first-line antituberculosis treatment with a subsequent satisfactory outcome. Conclusion: The retropectoral location in this pediatric patient led to a primary differential diagnosis of mastitis, despite the absence of signs of inflammation. This case underscores that tuberculosis should be considered in the differential diagnosis of atypical soft tissue masses or collections, even in sites not previously described in the literature. Retropectoral location as a manifestation of tuberculous spondylitis is a clinical rarity, offering a potential reference point for future research and highlighting the importance of timely histopathological diagnosis.