Female patient, 84 years old, Chilean nationality, housewife.
a The pattern was characterized by a multiple pathophysiologic symptoms of the other two months after the onset of asymptomatic ulcerated cutaneous erythematous nodules in the palm of the right finger and ventral area of the forearm
The patient had a history of essential hypertension, congestive heart failure, hypothyroidism and hemolytic anemia secondary to cryoagglutinins.
She had no previous history of tuberculosis, corticosteroid use, immunosuppression or recent trauma in the affected areas.
There was no relevant family history or travel in the last time.
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The differential diagnosis of subcutaneous mycosis, mycobacteriosis and tuberculous mycobacteriosis was proposed, performing biopsy and microbiological study of skin lesions.
Histopathological analysis revealed granulomatous plaque without caseification.
SAP, MG, Ziehl-Neelsen and Gram stains did not reveal the presence of microorganisms in the sample.
However, polymerase chain reaction (PCR) and tissue culture were positive for M. tuberculosis.
Blood count, sedimentation rate, HIV serology, biochemical profile, renal function, urine analysis, liver function and chest X-ray were all normal.
Quantiferon TB gold® determination was positive.
PPD was not performed.
1.
Based on the results, the diagnosis of tuberculosis was established and treatment was initiated with a primary scheme of four drugs: isoniazid, pyrazinamide, rifampicin and etambuco.
During two months of follow-up, the patient continued with the established anti-cracking therapy regimen, demonstrating a clinically significant improvement with regression of ulcerative lesions and no reported side effects.
