What is it about?
We present a teaching case of a 14-year-old refugee who had fled a war zone in the Middle East. He had chest pain for three months and, for two weeks, a 10-cm painful, red, warm swelling over the breastbone. He had no fever, cough or weight loss, and blood tests, including inflammation markers, were normal. He reported having been beaten at a border during his journey, which could suggest an infected bruise. A CT scan showed a deep abscess in front of the sternum and enlarged lymph nodes in the chest. The final diagnosis was chest wall tuberculosis, a rare form accounting for about 0.1% of tuberculosis cases, managed by aspiration of the abscess and antituberculosis therapy. The article is structured as a quiz to guide readers through the diagnostic reasoning.
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Why is it important?
Tuberculosis can mimic many other diseases, and extrapulmonary forms may present without typical symptoms or abnormal blood tests. In children and adolescents coming from high-incidence areas, including refugees, clinicians should keep a high index of suspicion to avoid diagnostic delays and unnecessary surgery.
Perspectives
Caring for refugees reminds us that their medical history includes the hardships of the journey, and that tuberculosis is still very much with us. This collaboration with paediatricians and radiologists in Trieste, a city on one of the main migration routes, aims to help young doctors recognize a classic great imitator.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Painful thoracic swelling in a refugee teenager, Archives of Disease in Childhood Education & Practice, August 2020, BMJ,
DOI: 10.1136/archdischild-2020-319658.
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