PMC6922018_01
Clinical images of a 35-year-old female patient who presented with a
three-month history of growing cutaneous lesions on the arms and legs:
A) brownish-red oval nodular papules and ulcerative nodular lesions of
variable sizes on the right leg. Some lesions are confluent; B) Growing
nodules covered by a purulent ulcer; C) A large ulcerative lesion
draining a seropurulent discharge, with irregular undermined borders and
surrounded by a thick rim of erythema. A central area of a hemorrhagic
crust is seen; D) A large rounded plaque covered by a scaling surface,
on the right arm.
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On clinical examination, there were around 20 brownish-red papules, plaques, nodules and ulcerative nodular lesions of variable sizes, some of which drained a seropurulent discharge, while others were covered with a hemorrhagic crust ( Figure 1 ).
Histopathological analyses of skin biopsy samples: A) Hematoxylin and
eosin staining reveals diffuse inflammatory infiltrate in the reticular
dermis, composed of histiocytes with abundant cytoplasm, as well as
lymphocytes, plasma cells and neutrophils (original magnification x 40);
B) Acid-fast staining unveils countless mycobacterial organisms
(original magnification x 400).
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An acid-fast staining of skin biopsies unveiled countless mycobacterial organisms, thus confirming the diagnosis of a cutaneous mycobacterial infection ( Figure 2 ).
A) Completely healed lesions with a hyperchromic scar; B) Immune
reconstitution inflammatory syndrome six months after antimycobacterial
treatment interruption. Redness and swelling at the precise locations of
the previously healed lesions. Molecular and histopathological analyses
failed to reveal mycobacteria. The lesions eventually improved
spontaneously, while the patient was not on antimycobacterial
treatment.
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The skin lesions had completely remitted, leaving hyperchromic scars ( Figure 3A ). Six months after the antimycobacterial treatment interruption, the patient noted tenderness, redness and swelling at the precise sites of the previously healed M. haemophilus cutaneous lesions ( Figure 3B ).