[Rare case of multifocal tuberculosis in Burkina Faso in a sickle cell SC patient with an atypical location: the sternoclavicular joint].

Abstract

Introduction: Tuberculosis and sickle cell disease are common in sub-Saharan Africa. Multifocal tuberculosis, more common in immunocompromised patients, is rare in SC sickle cell patients, especially when localized to the sternoclavicular joint.

Case report: A 44-year-old male sickle cell patient, black African, of Burkina Faso origin, with no other pathological history, presented with chronic inflammatory low back pain associated with right-sided inflammatory gonalgia and hacking cough. This symptomatology had been developing for 7 months in the context of fever and altered general condition. Examination revealed oligoarthritis of the right sternoclavicular joint and the left knee associated with pulmonary condensation syndrome and pleural effusion, a cold abscess in the right sternoclavicular joint, and a purulent fistulized right inguinal adenopathy. Biology revealed a biologic inflammatory syndrome. The GeneXpert test was positive in sputum, with no resistance to rifampin. Intradermal tuberculin test was positive. Chest CT revealed right sternoclavicular osteoarthritis and lumbar CT revealed L3-L4 spondylodiscitis. A standard radiograph of the left knee showed signs of arthritis. The diagnosis was tuberculosis with multifocal bone, pleural, and lymph node involvement. The patient was started on standard analgesics and antituberculosis drugs. The course was favorable.

Conclusion: Multifocal tuberculosis may affect SC sickle cell patients and requires vigilance to prevent complications, especially in rare articular localizations such as the sternoclavicular joint.