Images in Clinical Tropical Medicine Tuberculosis Abscess of the Chest Wall

Abstract. A 42-year-old male presented in June of 2011 with nocturnal fevers, night sweats, an 8-kg weight loss, and a cutaneous right chest wall mass. In March of 2013, a computed tomographic scan of the thorax showed a 54 +18 + 26-mm right lower lobe mass with peripheral calcifications, and in May of 2013, he was admitted for a segmental lobectomy, in which histologic examination of the pulmonary tissue revealed granulomas with multinucleated giant cells. The tissue was negative for acid-fast bacillae on Ziehl–Neelsen stain, and culture grew Mycobacterium tuber-culosis. Therefore, he was started on four first-line antituberculosis medications and showed rapid symptom-atic improvement. A 42-year-old male patient with an unremarkable past medical history presented in June of 2011 with nocturnal fevers, night sweats, an 8-kg weight loss, and a cutaneous right chest wall mass. He was started on multiple empirical anti-biotics for presumptive bacterial infection with no improve-ment. The mass progressed to two cutaneous chest wall fistulae, at which point additional empirical antibiotics were prescribed with minimal improvement. In March of 2013, h