Lubna Khondker, Farhana Wahab, Rehnuma Nasim, Hasan Mahmud.
Cutaneous tuberculosis with uncommon presentation: a case report and review of literature.
J Pak Assoc Derma Jun ;30(1):190-7.

Tuberculosis is a serious infection that affects many people worldwide, with a recent increasing prevalence especially in high-risk patients, such as HIV infection, intravenous drug abuse, diabetes mellitus, immunosuppressive therapy, malignancies, end-stage renal disease, and and/or with multiple comorbidities. Although the incidence of Cutaneous Tuberculosis (CTB) is rare, it should be considered in patients presenting with atypical skin lesions suggestive of an underlying infectious etiology. Most often TB is an airborne transmissible disease with skin manifestations presenting as a result of hematogenous spread or direct extension from a latent or active foci of infection. However, primary inoculation may occur as a direct introduction of the mycobacterium into the skin or mucosa of a susceptible individual by trauma or injury. Although rare, it is important for clinicians to recognize the many clinical variants of CTB to prevent missed or delayed diagnoses.  It is imperative that physicians have a high index of suspicion in order to quickly and effectively diagnose and treat these substantially morbid skin conditions. We report here a case with atypical presentation that we saw in our Out Patient Department (OPD). The aim of this communication is to bring to attention this often overlooked, but definitely curable clinical entity. This case report demonstrates the importance of a proper history and physical examination as well as diligent laboratory and diagnostic testing in determining the etiology of a suspicious and treatment-resistant skin lesion. Prompt consideration leads to a swift diagnosis and proper treatment resulting in high patient satisfaction.

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