Progressive Course of Pulmonary Tuberculosis Generating a Cold Abscess on the Chest Wall in a Case with Reduced Immunity

We presented a case of pulmonary tuberculosis invaded chest wall and caused cold abscess. A 58-year-old male patient was admitted to our hospital with a swelling on the left side of his back, discharge, and cough. He had been receiving dialysis therapy due to chronic renal failure for four years. On physical examination, a fixed smooth mass on the infrascapular region of the left hemithorax and 2cm below, a lateral incision with serous discharge were noted. Excisional biopsy had been performed on this region three weeks ago and the result had been reported as granulomatous dermatitis. The sputum smear was positive for AFB. On radiological examination inflammatory soft tissue changes, including multiple small abscess formations, were detected on chest wall and the parenchymal fibroproductive lesions were seen on the left lung's apical zone. Both lesions were found to begin from the same level, suggesting that the parenchymal lesion passed through the intercostal space and invaded chest wall. As a rare phenomenon, lung tuberculosis may follow a progressive course characterized by the development of a cold abscess on the chest wall, thus, this case was considered for presentation.