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Kamal Esalatmanesh, Zahra Soleimani
Am J Case Rep 2008; 9:415-418
Background: Mycobacterium tuberculosis is a multi-systemic infection. Extrapulmonary manifestation and pleural tuberculosis occurs in 5% of tuberculosis. M tuberculosis is rarely associated with cutaneous or osteoarticular infection. Overall cutaneous tuberculosis accounts for 14% of all cases of tuberculosis .
Case Report: Herein a case of mycobacterium tuberculosis infection presenting with cutaneous abscess,osteomylitis is reported. A 16-year-old Afghanian female immigrant presented to his internist with a 4×3 cm right ankle and foot abscess and cellulites, 3×3 cm left palmar abcess, 5×6 cm sternal abcess and cellulitis which had been present for 2 month. Foot X Ray reveal osteomylitis in third metatars and coniform. Spiral CT scan of the chest demonstrated a low density area (3.0×5.2 cm with central low density, suggestive of necrosis) with irregular border and enhancement inside the R.pectoralis major muscle with partial extension to the intra thorasic area. Purified protein derivative (PPD) was 22mm. Biopsy of soft tissue from foot (and culture) was negative for mycobacterium, fungi, and nocardia. Biopsy from bone reveal: caseous granulum, and growth of acid fast bacill (mycobacterium tuberculosis) after 45 days. The patient responded favorably to standard anti tuberculous regimen. Our case is very good after 12 months.
Conclusions: Cutaneous tuberculosis should be included in the differential diagnosis of patients with cutaneous abscesses or musculoskeletal complaints, particularly in high risk populations such as immigrants from endemic regions and immunosupressed patients. He underwent to cure and improvement
with anti tuberculous regimen.