Sternal osteomyelitis caused by Mycobacterium tuberculosis is rare; since the advent of modern antituberculous therapy, a limited number of detailed cases have been reported. Most patients were relatively young, free of underlying disease, and lived in a country in which tuberculosis is endemic. The disease presented indolently with sternal pain and swelling. Extrasternal disease is detectable in less than half. Diagnosis was based on histologic examination of infected tissues and mycobacterial cultures. Most patients recovered after surgical debridement and combination drug therapy. Tuberculous sternal osteomyelitis should be considered in patients with sternal pain and swelling.