Atypical chest wall pain: paravertebral tuberculosis mimicking costochondritis

BMJ Case Rep. 2025 Oct 10;18(10):e266521. doi: 10.1136/bcr-2025-266521.

Abstract

This case describes a woman in her 30s presenting with a 2 month history of thoracic pain, initially suspected to be costochondritis. The pain was unresponsive to conservative management, and imaging revealed a paravertebral mass at the T6-T7 level. The differential diagnosis included malignancy, sarcoma and tuberculosis (TB). A positive QuantiFERON-TB Gold test suggested TB exposure, before a biopsy subsequently confirmed spinal TB. She was started on quadruple anti-tuberculosis therapy and showed significant clinical improvement. This case emphasises the importance of considering TB in the differential diagnosis of costochondritis, particularly in recalcitrant cases.

Keywords: Sports and exercise medicine; Tuberculosis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antitubercular Agents / therapeutic use
  • Chest Pain* / diagnosis
  • Chest Pain* / etiology
  • Diagnosis, Differential
  • Female
  • Humans
  • Thoracic Vertebrae
  • Thoracic Wall
  • Tietze's Syndrome* / diagnosis
  • Tuberculosis, Spinal* / complications
  • Tuberculosis, Spinal* / diagnosis
  • Tuberculosis, Spinal* / drug therapy

Substances

  • Antitubercular Agents