The skeletal muscles are rarely affected by tuberculosis (TB) because they are not a favourable site for the survival and multiplication of Mycobacterium tuberculosis. A case of tuberculous abscess in rectus abdominis muscle is described in a 20-year-old apparently healthy female with no past history of TB. The diagnosis was made by ultrasound-guided fine-needle aspiration and cytological examination which revealed caseating granuloma with central necrosis, lymphocytes, and giant cells, consistent with TB. After four weeks of antituberculous treatment, she responded well and the abscess regressed considerably. In most cases, the muscle involvement is secondary and caused by haematogenous route or direct inoculation from a tuberculous abdominal lymph node or extension from underlying tubercular synovitis and osteomyelitis. The objective of this study was to alert clinicians and radiologists of the possibility of TB when considering the differential diagnosis of any lesion even in any unlikely anatomical area, especially in those regions where TB is endemic.
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