PMC10407729_01
Patient's physical examination on initial admission. 1 A: A physical examination revealed the presence of an irregular skin redness and swelling of size of about 3.0 cm x 2.5 cm at the posterior aspect of the midsection of the right leg. The surface could be covered by an irregular scab shell of about 1.00 cm x 0.8 cm. 1B: A red and swollen skin of size, 14 cm x 6.0 cm, was observed on the inner side of the right thigh. The texture of the local skin was relatively tough. Two oval skin ulcer wounds of about 2.0 cm x 1.0 cm were present.
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As shown in Fig. 1A, a physical examination revealed the presence of an irregular skin redness and swelling of size of about 3.0 cm x 2.5 cm at the posterior aspect of the midsection of the right leg. Two oval skin ulcer wounds of about 2.0 cm x 1.0 cm were present (Fig. 1B).
Changes in the patient's condition 3 days after discharge. Three days after discharge, the patient found a mass of about 4 cm x 4 cm in size on the medial side of the right thigh.
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Three days after discharge, the patient found a mass of about 4 cm x 4 cm in size on the medial side of the right thigh (Fig. 2).
Ultrasound results of the right thigh. An ultrasound examination showed a fluid accumulation under the right thigh root incision. The ranges of two dark areas under the right thigh root incision were 3.0 cm x 1.9 cm x 1.0 cm and 4.0 cm x 3.5 cm x 1.6 cm.
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The ranges of two dark areas under the right thigh root incision were 3.0 cm x 1.9 cm x 1.0 cm and 4.0 cm x 3.5 cm x 1.6 cm (Fig. 3).
Local puncture results. We performed a local puncture and extracted 25 ml of clear yellowish liquid.
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We performed a local puncture and extracted 25 ml of clear yellowish liquid (Fig. 4).
Condition of the patient's operating area during the operation. 5 A: During the operation, the skin, fat, and superficial fascia layers were cut to locate the two liquid dark areas shown by ultrasonography. The liquids in both areas were yellow and clear, and they communicated with each other through the sinus. Two swollen lymph nodes were found above the liquid dark area. 5B/5 C: After blunt separation, two dark and necrotic lymph nodes with sizes of 3.0 cm x 2.0 cm and 0.5 cm x 0.5 cm were found.
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After blunt separation, two dark and necrotic lymph nodes with sizes of 3.0 cm x 2.0 cm and 0.5 cm x 0.5 cm were found (Fig. 5).
Pathological examination results after surgery. Postoperative pathological examination showed that the right inguinal lymph node had undergone a caseous necrotizing granulomatous inflammation.
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A test for nucleic acids of Mycobacterium tuberculosis was negative (Fig. 6).