Disseminated multi-organ tuberculosis.

A 58-year-old immunocompetent man presented with a 6-month history of cough, fever and swelling of the upper chest wall. Computed tomography showed involvement of the clavicle, sternum, lungs, pleura and pericardium. Trans-bronchial biopsy of the lungs, and surgical debridement with partial resection of the manubrium revealed infection with Mycobacterium tuberculosis (Figs. 1 and 2). Fig. 1. Computed tomography of the thorax: (A) coronal reconstruction depicting bilateral involvement of the lungs, with multiple small, centrilobular nodules connected to linear branching opacities. This so-called tree-in-bud appearance is typically seen in post-primary tuberculosis. (B) Chronic calcify-ing pericarditis (arrow). (C) Pleural effusion and thickening (arrow). Fig. 2. The patient lived in Brazil, which is an endemic area for Mycobacterium tuberculosis infection. At initial consultation, there was: (A) fistulous lesion in the sternum, with drainage of purulent material (arrow). (B) Cold abscess of chest wall (arrow), involving the right sterno-clavicular joint. (C) Osteolytic destruction of the sternum (arrow), compatible with osteomyelitis.