PMC3201101_01
(A) Swelling of the feet and (B) skin ulcer observed 2 weeks before hospital admission.
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Two weeks before hospital admission, he presented with bilateral swelling of the fingers and feet (Fig. 1A). Further, the skin eruption had progressed to ulceration (Fig. 1B).
(A) Thoracic computed tomography (CT) obtained 2 weeks before hospital admission, showing tiny nodules with no abnormal shadows. (B) CT scan obtained upon admission, showing shadows and nodules on both lung fields. (C) CT scan obtained shortly before discharge from the hospital, showing almost complete disappearance of the shadows.
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Chest X-ray (CXR) findings were normal, but computed tomography (CT) revealed the presence of tiny miliary nodules in both lung fields (Fig. 2A). About 2 months after admission, the bilateral infiltrates had almost completely disappeared from the lungs (Fig. 2C), and the patient was discharged.
Posteroanterior chest radiograph obtained upon hospital admission, showing diffuse bilateral infiltration.
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CXR showed diffuse bilateral infiltration (Fig. 3), and CT revealed the presence of multiple nodules and infiltrates in both lung fields (Fig. 2B).
Biopsy of the skin ulcer (hematoxylin and eosin, 200x), revealing infiltration of mixed inflammatory cells, small vessel proliferation in the dermis, and epidermal proliferation. Dermal granulomas were not observed.
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Skin biopsy which was done at 1 weak after admission revealed diffuse infiltration of mixed inflammatory cells in the dermis, which was consistent with the diagnosis of cutaneous NTM infection (Fig. 4).