[Cold thoracic parietal abscess in immunocompetent individuals]

From Plasmacytoma to Rib Tuberculosis: The Case of A Breast Mass With An Unexpected Diagnosis

Tuberculosis (TB) of the rib is an uncommon manifestation of extrapulmonary TB that can pose significant diagnostic challenges, especially when presenting as a breast mass. We report the case of a 74-year-old woman who presented with a left breast lump, initially suspected to be a plasmacytoma due to its imaging characteristics and clinical history. The mass was surgically excised, and histopathological analysis revealed granulomatous inflammation with caseous necrosis, suggesting TB. TB-polymerase chain reaction confirmed the diagnosis, despite negative Ziehl-Neelsen staining. The patient was treated with anti-tubercular therapy for twelve months, resulting in a favorable clinical outcome. This case highlights the importance of considering rib TB in the differential diagnosis of breast masses, particularly in endemic areas, and underscores the role of comprehensive diagnostic evaluations for timely and effective treatment.

The diagnostic challenge of a tuberculous cold abscess of the epididymis: a case report

Background

While genitourinary tuberculosis is a common form of extra-pulmonary tuberculosis, cold abscess of the epididymis is rare with our literature search finding no reports from the West African subregion. Where the index of suspicion is low, diagnosis is missed and unnecessary surgery may be performed on suspicion of a tumour. The aim of this case report is to highlight the diagnostic challenges of this condition in resource-limited settings in order to create awareness within the health community, increase the chance of appropriate diagnosis, thereby facilitating early commencement of treatment so as to avoid needless testicular loss or complications, such as infertility.

Case presentation

A 33-year-old Black African College-educated public service employee resident in Abuja, Nigeria, presented with a one-week history of right scrotal pain and swelling. Genital examination revealed a firm, non-tender epididymal mass which was initially mistaken for a malignancy. There were no constitutional symptoms, and the contralateral testis was normal. The swelling involved only the epididymis. The testis was distinctly palpable but not oedematous. There was some hemi-scrotal oedema. Blood count and urine cultures were normal. Ultrasound scan showed a hypoechogenic, uniformly enlarged epididymis. Testicular tumour markers were negative. However, CT-abdomen showed enlarged para-caval and pelvic nodes which were thought to be due to secondary deposits from a testicular tumour. Scrotal swelling was later found to be due to an abscess of the epididymis at surgery. Histology showed caseous granulomas typical of Mycobacterium tuberculosis. Gene-Xpert, a cartridge-based nucleic acid amplification test, later confirmed that patient had tuberculosis, for which he is being treated.

Conclusion

The differential diagnosis of an epididymal cold abscess from testicular tumour or chronic epididymitis can be challenging. Therefore, a high index of suspicion as well as a complete tuberculosis screen is essential in an apparently healthy patient presenting with a chronic epididymal swelling.