Tuberculous Lymphadenitis Presenting as Chest Wall Cold Abscess: A Case Report

Tuberculosis (TB) is a significant global health challenge, with chest wall involvement representing a rare extrapulmonary manifestation. Tuberculous cold abscess of the chest wall is particularly infrequent. This case describes a 59-year-old female with chronic back pain and a non-tender swelling on the anterolateral chest wall. Advanced imaging revealed enlarged, conglomerate subcarinal lymphadenopathy and a cold abscess associated with osteolytic destruction of the ninth rib, without pulmonary involvement. Microbiological evaluation confirmed the presence of Mycobacterium tuberculosis, and cytological examination demonstrated granulomatous inflammation with caseous necrosis and Langhans giant cells, supportive of TB. The patient was treated with a weight-based, first-line antitubercular therapy regimen for 11 months. Complete resolution of the swelling was achieved by the fifth month, and the patient remained asymptomatic, with no recurrence at the final follow-up. This case posed a significant diagnostic challenge, as chest wall TB can mimic pyogenic infections or primary chest wall malignancies, making imaging and microbiological testing essential for accurate diagnosis and treatment.