A ten-year-old boy presented with cleft palate and cleft palate in the thigh, and an inguinal adenopatic conglomerate, accompanied by intermittent fever.
The entrance door was a foot wound produced on a Brazilian beach weeks before, which had not healed.
Despite treatment with intravenous amoxicillin-clavulanate, the symptoms did not improve.
The ultrasound showed an adenopatic conglomerate.
Needle aspiration biopsy (FNAB) of the adenopathies showed histologically epithelioid granulomas with necrosis.
The Mantoux test showed an induration of 20 mm in diameter with vesicles and necrosis at 48 hours.
Quantification of interferon gamma was positive.
He had not been vaccinated with BCG.
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A foot wound biopsy was performed and polymerase chain reaction was positive for DNA detection of Mycobacterium tuberculosis (PCR-TB).
Isoniazid-sensitive Mycobacterium tuberculosis was microbiologically confirmed in the culture of FNAB and skin biopsy.
Chest X-ray and chest computed tomography (CT) were normal, and smears and cultures of gastric juice were negative.
The immune study (with detection of immunoglobulins, cellular immunity and serology for human immunodeficiency virus) was normal.
Anticonvulsant therapy was initiated with isoniazid, rifampicin and pyrazinamide.
This had to be ruled out after the appearance of a pruriginous cutaneous exanthema caused by pyrazinamide, which disappeared after its withdrawal.
One month later there were two deep cutaneous fistulas that required surgical debridement.
After six months of treatment, cutaneous scrofula and inguinal lymphadenopathy were resolved.
No contact was detected with the bacilliferous patient and the family study with the Mantoux test was negative.
