Cutaneous tuberculosis mimicking a mycetoma: a case report
A 90-year-old male, farmer by occupation, had skin lesion over the left leg for the last 10 years. The lesion was asymptomatic, but in the last 30 days, nodules developed over that site were painful and itchy.

Those nodules gradually increased in size and then foul smelling discharge started from multiple sinuses. There was no history of trauma over that site in recent past. The patient did not give a history of fever, cough, cold, and TB in past. Patient had no other systemic complaints. Patient had taken ayurvedic treatment, but there was no improvement.

Cutaneous examination showed multiple serosanguinous discharging sinuses with deep nodules and ulcerative lesions over the left leg with surrounding erythema and mild edema.

Gram stain of pus collected from the site of the lesion revealed moderate number of capsulated Gram-negative bacilli with scanty pus cells. Potassium hydroxide wet mount of that pus revealed no fungal morphology. Ziehl–Neelsen stain was negative. Pus culture detected Aeromonas hydrophila. Mantoux test was negative.

Biopsy demonstrated many epithelioid cell granulomas with central caseous necrosis and periphery arranged epithelioid cells and Langhans giant cells.

Anti-Koch's treatment category 2 was given to the patient for 8 months and the patient improved within 2 months of treatment

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Dr. M●●●u G●●●a General Medicine
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Oct 13, 2018Like