case_images: PMC9167051_01
case_images: Pustules on upper extremities (A-C). Pustules, erythematous nodules and shallow ulcers on right lower arm (D).
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case_images: There were pustules on the center of erythematous nodules on the extremities (Figure 1A-C), erythematous nodules, and shallow ulcers (Figure 1D).
case_images: Direct microscopical examination, taken from pustules: with ZN staining, notice the AFB is contained within the pus, marked by yellow arrows (A); and with Gram staining, there are only polymorphonuclear cells without bacteria are found (B).
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case_images: Direct microscopic examination of the pus with Ziehl-Neelsen (ZN) staining revealed acid-fast bacilli (AFB) (Figure 2A), and Gram staining revealed no bacteria (Figure 2B).
case_images: Skin lesion after the ninth day of minocycline and prednisone combination. Pustules had subsided, leaving hemorrhagic crusts and hyperpigmented macules. There was no new lesion observed on this state (A--D).
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case_images: The minocycline dose was sustained for four weeks, while the prednisone was able to be tapered without any recurring lesions (Figure 3A-D).