Sternal Osteomyelitis Caused by Mycobacterium tuberculosis in a Heart Transplant Patient

TL;DR

A heart transplant patient developed sternal osteomyelitis caused by tuberculosis, which was successfully treated with antituberculous therapy.

Contribution

This case highlights the importance of diagnosing atypical extrapulmonary tuberculosis in immunocompromised patients.

Findings

Chronic sternal wound secretion in a heart transplant patient was diagnosed as tuberculosis.

Granulomatous inflammation and Langhans cells confirmed the diagnosis.

Six months of antituberculous therapy resolved the infection and healed the wound.

Abstract

Mycobacterium tuberculosis (MT) infection poses a significant risk in immunocompromised individuals, particularly in areas with high MT prevalence. We describe the case of a 43-year-old heart transplant recipient who developed chronic sternal wound secretion post-transplant surgery. Imaging revealed signs of inflammatory tissue suggestive of chronic osteomyelitis. Removal of the sternal wires was performed, followed by biopsy, which identified granulomatous inflammatory tissue and Langhans cells, that led to the diagnosis of MT infection later confirmed in culture results. The patient completed a 6-month tetraconjugate antituberculous therapy, resulting in successful wound healing and infection resolution. Atypical extrapulmonary MT manifestations require high clinical suspicion, especially in immunocompromised patients, to ensure timely diagnosis and treatment with favorable outcomes.

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