Soft Tissue Tuberculosis Mimicking Ewing Sarcoma: A Case Report

Abstract

Introduction: Mycobacterium tuberculosis is a disease seen in every tissue and organ. Although it often involves the lung and pleura, it can also progress into extrapulmonary tuberculosis. Soft tissue and bone tuberculosis are the least common of all tuberculosis types. In some cases, the lesions may appear like bone tumors or metastatic lesions. Bacteriological and histopathological studies reach a definitive diagnosis because of the biopsy. We present a case suggestive of Ewing's sarcoma with clinical and imaging findings diagnosed as soft tissue tuberculosis resulting from the biopsy. Case: A two-year-old girl was admitted to our clinic with the complaint of palpable swelling on the left side of her chest. Ewing sarcoma was considered with the findings of Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and PET-CT. Biopsy material was reported as casefied granulomatous inflammation, and M. tuberculosis complex DNA was detected by PCR examination of the tissue. The patient was successfully treated with rifampin, isoniazid, pyrazinamide, and ethambutol. Conclusion: Today, it should be kept in mind that tuberculosis is a common disease, rarely isolated soft tissue or bone involvement, and can be confused with malignancy.

Keywords

• Child
• Ewing sarcoma
• Chest wall mass
• tuberculosis

References

1. 1. González Saldaña N, Macías Parra M, Arias de la Garza E, et al. Case Report: Chest Wall Tuberculosis without Pulmonary Involvement in Three Pediatric Immunocompetent Patients. The American Journal of Tropical Medicine and Hygiene. 2019;101(5):1073-1076.
2. 2. Morris BS, Varma R, Garg A, Awasthi M, Maheshwari M. Multifocal musculoskeletal tuberculosis in children: appearances on computed tomography. Skeletal radiology. 2002;31(1):1-8.
3. 3. Wong KS, Hung IJ, Wang CR, Lien R. Thoracic wall lesions in children. Pediatric Pulmonology. 2004;37(3):257-263.
4. 4. Yazol M, Boyunaga O. Kemigin Indiferansiye Kucuk Yuvarlak Hucreli Sarkomlari ve Radyolojik Bulgulari. Türk Radyoloji Seminerleri. 2021;9(1):124-136.
5. 5. Stefanowicz J, Stachowicz-Stencel T, Adamkiewicz-Drozynska E, Synakiewicz A, Kosiak W, Balcerska A. When biopsy of the tumour is necessary to diagnose tuberculosis. Journal of paediatrics and child health. 2011;47(6):397-398.
6. 6. Teo HEL, Peh WCG. Skeletal tuberculosis in children. Pediatric Radiology. 2004;34(11):853-860.
7. 7. Kaur S, Thami GP, Gupta PN, Kanwar AJ. Recalcitrant Scrofuloderma Due to Rib Tuberculosis. Pediatric Dermatology. 2003;20(4):309-312.
8. 8. Hosalkar HS, Agrawal N, Reddy S, Sehgal K, Fox EJ, Hill RA. Skeletal tuberculosis in children in the Western world: 18 new cases with a review of the literature. Journal of Children’s Orthopaedics. 2009;3(4):319-324.

9. 9. Dewan P, Tandon A, Rohatgi S, Qureshi S. Multifocal tuberculous osteomyelitis in a 3-year-old child. Paediatrics and International Child Health. 2017;37(2):152-154.
10. 10. Özkara Ş, Kılıçaslan Z, Öztürk F, et al. Bölge Verileriyle Türkiye’de Tüberküloz. Toraks Dergisi. 2002;3(2):178-187.