PMC6479154_01
(A) Ulcers in the cervical region. (B) Ulcers behind the ear. (C) Ulcers with pustulated sinus and purulent caseous discharge.
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The lesion began as papules that gradually developed into nodules, pustules and painless suppurative ulcer (Fig. 1A). Physical examination revealed ulcer with suppurative surface in the bottom part, along with nodule measuring 4 cm x 0.5 cm (Fig. 1A). Around his ear, some crusts were found measuring 3 cm x 0.5 cm typical for scrofuloderma (Fig. 1B). In axillary region, there were also painless ulcers with pustulated sinus and purulent discharge, surrounded by bluish and edematous skin surface (Fig. 1C).
(A&B) CT Scan of the cervical region revealed multiple lymph node enlargement suggestive for tuberculous lymphadenitis. (C) Showed groups of epitheloid cell with spindle nucleous with chromatin granules spread equally, surrounded with basophilic amorf mass and fibrous tissue suggestive for tuberculous lymphadenitis.
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He underwent CT Scan of the cervical region and multiple lymph node enlargement was found, suggestive for tuberculous lymphadenitis (Fig. 2Aand B). The background staining of the smear was mature lymphocyte, lymphoblast, neutrophil and macrophage, confirming the diagnosis of tuberculous lymphadenitis (Fig. 2C).
(A&B). Four months later, the lymph node enlargement in supraclavicular region was getting smaller, ulcers in the neck began to heal. (C) Ulcers in the axillary region resolved leaving scar tissue.
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Isoniazid (H), Pyrazinamid (Z), and Ethambutol (E) for 2 months continued by Rifampicin (R), Isoniazid (H) for the next 4 months. In the fourth months, the lymph node enlargement in the cervical region were shrinked (Fig. 3A and B). The ulcers in the neck and axilla began to resolve gradually leaving scar tissue (Fig. 3C).