PMC9167051_01
Pustules on upper extremities (A-C). Pustules, erythematous nodules and shallow ulcers on right lower arm (D).
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There were pustules on the center of erythematous nodules on the extremities (Figure 1A-C), erythematous nodules, and shallow ulcers (Figure 1D).
Direct microscopical examination, taken from pustules: with ZN staining, notice the AFB is contained within the pus, marked by yellow arrows (A); and with Gram staining, there are only polymorphonuclear cells without bacteria are found (B).
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Direct microscopic examination of the pus with Ziehl-Neelsen (ZN) staining revealed acid-fast bacilli (AFB) (Figure 2A), and Gram staining revealed no bacteria (Figure 2B).
Skin lesion after the ninth day of minocycline and prednisone combination. Pustules had subsided, leaving hemorrhagic crusts and hyperpigmented macules. There was no new lesion observed on this state (A--D).
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The minocycline dose was sustained for four weeks, while the prednisone was able to be tapered without any recurring lesions (Figure 3A-D).