PMC5491827_01
Skin lesions of the buttock and the thigh. (a) Broad erythema on the left buttock (after a biopsy). (b) Erythema on the inside of the left thigh at the time of relapse. (c) Multiple subcutaneous indurations after four months of combined antibiotics treatment from the time of relapse.
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However, the local redness and pain extended further (Fig. 1a). However, she experienced a relapse three weeks later, and cutaneous redness and induration occurred at a new lesion on the wide area of the inside of the left thigh and on the right buttock (Fig. 1b). The cutaneous lesion gradually improved, and her general condition was stable; however, the subcutaneous induration partially remained (Fig. 1c).
(a) Histological appearance of the left buttock lesion, showing inflammatory cell infiltration and formation of granuloma (Hematoxylin and Eosin staining, x100). (b) Acid-fast bacilli (arrow) in the regions (Kinyoun stain, x400).
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The histopathological findings revealed inflammatory cell infiltrates that were mainly composed of lymphocytes and plasma cells extending from the dermis into the subcutaneous fat as well as granuloma formation (Fig. 2a). Furthermore, a microscopic examination of a direct smear showed slight positivity for acid-fast bacilli (+/-, equivalent to Gaffky scale of 1) (Fig. 2b).
Clinical course of the patient. INH: isoniazid, REP: rifampicin, EB: ethambutol, CAM: clarithromycin, AZM: azithromycin, IPM/CS: imipenem/cilastatin, FRPM: faropenem, AMK: amikacin, KM: kanamycin, MINO: minocycline, LVFX: levofloxacin, MFLX: minocycline, LZD: linezolid
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Finally, a three-drug combination of azithromycin, moxifloxacin, and minocycline was administered, and she was discharged in the tenth month after hospitalization (Fig. 3).