PMC3514062_01
PMC3514062_02
Skin lesions. (A and B) Before treatment a large area of immersed erythema and edema with nodules, ulcerations, and crusts scattered on the right upper limb was present. A nummular deep ulcer with a severe tenderness presented on the back side of the second digit. (C and D) After 2 months of therapy the skin nodules decreased in size and the ulcer cavity was filled with fresh tissues. (E and F) After 6 months of therapy the lesions subsided, leaving some hyperplastic scars.
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He had a nummular deep ulcer with severe tenderness on the dorsum of the second digit, which limited movement (Figure 1A and B). Surprisingly, the skin nodules rapidly decreased in size, and ulcer cavities had fresh tissue within several weeks (Figure 1C and D). After this period, the lesions had significantly subsided, leaving hyperplastic and atrophic scars, and new nodules did not recur (Figure 1E and F).
Pathological changes.. Note: A neutrophilic and histiocytic granuloma (hematoxylin and eosin; original magnification x400).
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Multinucleated giant cells were also observed (Figure 2).
Pathogenic organism. (A) Mycobacterial cultures from the isolated lesional skin. (B) Smear from the cultured organisms with acid-fast stain.
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Tissue cultures showed that the colonies grew on Lowenstein-Jensen (LJ) medium at 32 C for 10 days (Figure 3).