Delayed diagnosis of scrofuloderma misdiagnosed as a bacterial abscess.

Annals of Dermatology
Gun-Wook KimEun-Kyung Sim

Abstract

An 82-year-old woman presented with a four-month history of an ulcerative plaque overlying her left neck. This lesion had developed as a subcutaneous nodule, gradually increased in size, and evolved into ulcers. Before visiting our Dermatology clinic, the patient had been diagnosed as having a bacterial abscess, but treatments with antibiotics were unsuccessful. The presence of a purulent discharge and prominent ulceration caused further confusion as bacterial abscess, and radiologic evaluation on computed tomography also led to the possibilities of secondary lesions from an abscess or malignancy. However, the characteristic appearance of her lesion allowed us to discern cutaneous tuberculosis, especially scrofuloderma. Based on clinical examinations, staining for acid-fast bacilli, and positive findings of polymerase chain reaction, a quick diagnosis of scrofuloderma was made. After that, she was treated successfully with anti-tuberculosis therapy and the ulcer healed. Our case highlights the problem of delayed diagnosis of scrofuloderma presenting as a bacterial abscess. In conclusion, having a high index of suspicion is needed to diagnose cutaneous tuberculosis correctly.

References

May 1, 1990·International Journal of Dermatology·V N Sehgal, S A Wagh
Dec 1, 1988·Journal of the American Academy of Dermatology·G LantosM Contreras
Jun 19, 2002·American Journal of Clinical Dermatology·Joseph BarbagalloJeffrey M Weinberg
Mar 26, 2003·International Journal of Dermatology·Ilknur Kivanç-AltunayAdem Köslü
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Jun 20, 2008·Dermatologic Therapy·Evangeline B HandogRosario Trinidad V Pineda

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Citations

Dec 10, 2013·Clinics in Dermatology·Suhan Günaştı, Varol L Aksungur
Dec 1, 2015·Tuberculosis·Lindi van ZylJoe Viljoen
Apr 29, 2014·Anais Brasileiros De Dermatologia·Josemir Belo Dos SantosVanessa Lucília Silveira de Medeiros
Apr 4, 2019·JAMA Dermatology·Sarah OberhelmanTania Phillips
Apr 20, 2021·Annals of Medicine and Surgery·Ayoub SabrFaiçal Slimani
Dec 5, 2019·Skin Appendage Disorders·Ana Cristina da Silva SousaRita Guedes

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Methods Mentioned

BETA
X-ray
biopsy
PCR

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