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Tuberculosis even in countries where tuberculosis is endemic like Pakistan. Frank presentation as
discharging sinus is even more uncommon. We describe a case where a patient presented with
constitutional symptoms of fever, loss of appetite, significant weight loss and an erythematous tender lesion
over the sternum with a discharging sinus without any features of pulmonary tuberculosis. The case was
initially not diagnosed by routine laboratory tests and the lesion was just considered as a boil until
presented to tertiary care hospital as discharging sinus. Plain Radiographs showed lytic lesion on the
inner aspect of sternum and histopathology of the aspirate from the lesion confirmed the presence of
epithelioid granulomas and acid fast bacilli on staining. Patient responded very well to 12 months of antituberculosis treatment.
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