case_images: PMC6922018_01
case_images: Clinical images of a 35-year-old female patient who presented with a
  three-month history of growing cutaneous lesions on the arms and legs:
  A) brownish-red oval nodular papules and ulcerative nodular lesions of
  variable sizes on the right leg. Some lesions are confluent; B) Growing
  nodules covered by a purulent ulcer; C) A large ulcerative lesion
  draining a seropurulent discharge, with irregular undermined borders and
  surrounded by a thick rim of erythema. A central area of a hemorrhagic
  crust is seen; D) A large rounded plaque covered by a scaling surface,
  on the right arm.
case_images: 1678-9946-rimtsp-61-S1678-9946201961071-gf01.jpg
case_images: PMC6922018_01_1678-9946-rimtsp-61-S1678-9946201961071-gf01.jpg
case_images: f01
case_images: On clinical examination, there were around 20 brownish-red papules, plaques, nodules and ulcerative nodular lesions of variable sizes, some of which drained a seropurulent discharge, while others were covered with a hemorrhagic crust ( Figure 1 ).
case_images: Histopathological analyses of skin biopsy samples: A) Hematoxylin and
  eosin staining reveals diffuse inflammatory infiltrate in the reticular
  dermis, composed of histiocytes with abundant cytoplasm, as well as
  lymphocytes, plasma cells and neutrophils (original magnification x 40);
  B) Acid-fast staining unveils countless mycobacterial organisms
  (original magnification x 400).
case_images: 1678-9946-rimtsp-61-S1678-9946201961071-gf02.jpg
case_images: PMC6922018_01_1678-9946-rimtsp-61-S1678-9946201961071-gf02.jpg
case_images: f02
case_images: An acid-fast staining of skin biopsies unveiled countless mycobacterial organisms, thus confirming the diagnosis of a cutaneous mycobacterial infection ( Figure 2 ).
case_images: A) Completely healed lesions with a hyperchromic scar; B) Immune
  reconstitution inflammatory syndrome six months after antimycobacterial
  treatment interruption. Redness and swelling at the precise locations of
  the previously healed lesions. Molecular and histopathological analyses
  failed to reveal mycobacteria. The lesions eventually improved
  spontaneously, while the patient was not on antimycobacterial
  treatment.
case_images: 1678-9946-rimtsp-61-S1678-9946201961071-gf03.jpg
case_images: PMC6922018_01_1678-9946-rimtsp-61-S1678-9946201961071-gf03.jpg
case_images: f03
case_images: The skin lesions had completely remitted, leaving hyperchromic scars ( Figure 3A ). Six months after the antimycobacterial treatment interruption, the patient noted tenderness, redness and swelling at the precise sites of the previously healed M. haemophilus cutaneous lesions ( Figure 3B ).