CTICasesDisseminated Mycobacterium africanum Infection with Bone and Soft-Tissue Involvement
Imaging findings
A 27-year-old woman who had emigrated from West Africa presents with chest and buttock pain and neck swelling. Imaging shows a destructive lytic lesion with an associated soft-tissue mass in a posterior rib, subcarinal lymphadenopathy, and a destructive process with necrosis centered on the sacrococcygeal region; follow-up imaging eight months later shows a new chest-wall abscess with residual, only partially improved bone and nodal disease.
Key takeaways
Multifocal lytic bone lesions, lymphadenopathy, and soft-tissue abscesses in a young West African immigrant should prompt consideration of mycobacterial disease even without pulmonary symptoms, since the lungs can serve only as the portal of entry with hematogenous or lymphatic spread seeding bone and soft tissue; cultures here grew Mycobacterium africanum, a member of the M. tuberculosis complex concentrated almost exclusively in West Africa and reported only rarely in the United States, generally in patients with a West African immigrant background.
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