SA Orthopaedic Journal
Print version ISSN 1681-150X
OBJECTIVE: Tuberculous osteomyelitis of the sternum is rare. With the increased incidence of HIV seropositivity, atypical musculoskeletal manifestations of tuberculosis (TB) are becoming more common. The aim of this study was to review the clinical presentation, diagnosis, treatment and outcome of patients presenting with tuberculous involvement of the sternum. METHODS: A retrospective chart review was performed on all patients with tuberculous involvement of the sternum, with specific reference to: age, gender, clinical presentation, HIV status, CD4 count, antiretroviral treatment, co-morbidities, diagnosis, management and outcomes. RESULTS: Fourteen patients with sternal TB were reviewed at King George V Hospital from May 2006 to June 2008. The average age was 17.5 years. All 14 cases had infective spondylitis with associated sternal involvement. There were no cases of primary sternal TB. There were three cases of delayed diagnosis that presented with severe spinal and anterior chest wall deformities. The diagnosis was suspected clinically in seven patients and an incidental finding in the remaining seven. Sternal lesions on lateral radiographs were only picked up in two patients. MRI was diagnostic in all 14 patients. The disease was multifocal in all cases. Seven patients had multiple level, non-contiguous infective spondylitis. It was noted that all patients had a lesion in the dorsal spine. Six patients were HIV-positive, with average CD4 counts of 277 (110-696). None of the patients were on antiretroviral therapy prior to the diagnosis of sternal TB. The sternal component of the disease was managed non-operatively with antituberculous chemotherapy. Average follow-up was 14 months (3-22). All patients responded well to therapy. CONCLUSION: Atypical manifestations of TB are becoming increasingly prevalent. Due to increased awareness among clinicians and improved imaging techniques, the diagnosis of sternal TB is easier to make and treatment with antituberculous chemotherapy appears to be an effective management strategy.