Very long standing fever in an immunocompetent host

We present a case of 7 years history of recurrent febrile syndrome associated with constitutional symptoms. Extensive investigations failed to identify an etiological agent. Actually, the patient presents herself with a chest wall tumor and supraclavicular adenopathy.

Computerized tomography (CT) disclosed chest wall abscess, adjacent costal lytic lesions, pulmonary fibrosis in the left centrohilar area, mediastinal lymphadenopathy, pericardial effusion, partial portal vein thrombosis, multiple hepatic and splenic hypodense lesions and abdominal lymphadenopathy.

The anatomo-pathological examination of chest wall abscess and supraclavicular adenopathy revealed epithelioid cell granuloma with caseous necrosis. The evaluation for immunocompromised status has found no significant anomaly.

Antituberculosis chemotherapy resulted in resolution of fever and clinical improvement.

Final diagnosis: disseminated tuberculosis (lymph node, chest wall abscess, pericardial, hepatic, splenic and pulmonary?) complicated with partial portal vein thrombosis in an immunocompetent host.