Awad Ali M Alawad1* and Mohamed D Gismalla2
1Department of Surgery, University of Medical sciences and Technology, Sudan
2Department of Surgery, University of Gezira, Sudan
Received:01 August, 2015;Accepted: 12 August, 2015;Published: 14 August, 2015
Awad Ali Mohamed Ahmed Alawad, Department of Surgery, University of Medical Sciences and Technology, Sudan, Tel: 00249912802545; E- mail:
Alawad AAM, Gismalla MD (2015) Tuberculous Abscess of the Anterior Abdominal Wall: An Unusual Site of Presentation. Global J Med Clin Case Reports 2(1): 008-009.DOI: 10.17352/2455-5282.000017
© 2015 Alawad AAM. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Skeletal muscle tuberculosis; Intramuscular abscess; Antituberculous drugs therapy
The skeletal muscles are rarely affected by tuberculosis because they are not a favorable site for the survival and multiplication of Mycobacterium tuberculosis. A case of tuberculous abscess in rectus abdominis muscle is described in a 20- year- old female in an apparently healthy individual without any past history of tuberculosis. The diagnosis was made by ultrasound-guided fine-needle aspiration and cytological examination which revealed caseating granuloma with central necrosis, lymphocytes, and giant cells, consistent with tuberculosis. After four weeks' antituberculous treatment, she responded well and the abscess regressed considerably. In most cases, the muscle involvement is secondary and is caused by either hematogenous route or direct inoculation from a tuberculous abdominal lymph node or extension from underlying tubercular synovitis and osteomyelitis. This case cautions the clinicians and radiologists about the possibility of tuberculosis in considering the differential diagnosis of any lesion even in any unlikely anatomical area, especially in those areas where tuberculosis is endemic.
The skeletal type of muscles are rarely affected by tuberculosis (TB) because they are not a preferred site for the survival and multiplication of Mycobacterium tuberculosis . Even in patients with widespread involvement by the disease, tuberculosis rarely involves muscles. Petter et al. recorded only one case of primary skeletal muscles tuberculosis in over 8,000 cases of all types of tuberculosis, with an incidence of 0.015% . Few cases of tubercular myositis have been described in literature till now, mostly in the adults. This, together with the decline in tuberculosis in general, makes it unlikely that one would immediately consider tuberculosis as the cause of rectus sheath abscess.
There are only limited cases reports of isolated tubercular involvement of the anterior abdominal wall even though tuberculosis is a rampant in developing countries and with the rapid spread of acquired immune deficiency syndrome (AIDS) it has made inroads into the developed nations as well . We are presenting a case of primary tuberculous abdominal wall abscess without any evidence of pulmonary, skeletal or gastrointestinal tuberculosis in an immune competent patient. This case report should serve as a reminder that tuberculosis, in all of its various manifestations, is still very much among us.
A 20-year-old female presented to the outpatient department of surgery, with a complaint of a progressive swelling in the left lower abdomen for the last three months. There was no history of preceding trauma, fever, cough, malaise or pain. There was no history of contact with any case of tuberculosis. On examination, there was swelling in the left iliac fossa measuring 8x8cm in size, non-tender with smooth and ill-defined margins and a normal overlying skin. The swelling was firm in consistency and moved with respiration. Examinations of the cardiovascular and respiratory system were within normal limits.
Laboratory investigation revealed: hemoglobin 11.5 g/dl; total leukocyte count 8510/cumm with a differential count of 54% neutrophils, 42% lymphocytes and 4% eosinophils; Erythrocyte Sedimentation Rate 70 mm and ELISA for HIV negative. The chest radiograph was unremarkable. Other biochemical blood investigations were within normal limits. Ultrasonography of the abdomen revealed a 6.5x8.5cm left iliac fossa cystic mass with a liquefied necrotic center in the anterior abdominal wall (Figure 1). Computerized Tomography scan of the abdomen showed an abscess in the left antero-lateral portion of the abdominal wall limited to the muscle layer (Figure 2). Ultrasound-guided fine-needle aspiration and cytological examination revealed caseating granuloma with central necrosis, lymphocytes, and giant cells, consistent with tuberculosis (Figure 3). The patient was diagnosed to have tuberculous abscess of the anterior abdominal wall and antituberculosis treatment was started. She improved rapidly over the next few days. After four weeks' antituberculous treatment (ATT), she responded well to the treatment and the abscess regressed considerably. ATT was continued for 9 months.
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