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.