SALIENT FEATURESALIENT FEATURE

Mr. Sharif, aged 40 Years, hailed from Mr. Sharif, aged 40 Years, hailed from

Mymensingh Jail, came to MMCH on 06-04-06 Mymensingh Jail, came to MMCH on 06-04-06

with the complaints of: with the complaints of:

1. 1. One rough surfaced elevation of skin in the One rough surfaced elevation of skin in the

left axilla for 3 left axilla for 3 ½ years and another same ½ years and another same

type of elevation of skin on the right foot type of elevation of skin on the right foot

for 2½ years.for 2½ years.

2.2. Numerous small elevations of skin over Numerous small elevations of skin over

the the back and right side of the trunk for back and right side of the trunk for

4 4 months. months.

3.3. Mild cough for 6 months.Mild cough for 6 months.

On Examination – The lesion in the left On Examination – The lesion in the left

axilla reveals warty, fissured, rough, plaque axilla reveals warty, fissured, rough, plaque

type type

lesionlesion extending from anterior axillary extending from anterior axillary

fold in an irregular and linear fashion up fold in an irregular and linear fashion up

to the posterior axillary fold.to the posterior axillary fold. The apical The apical

axillary lymph node is palpable and non axillary lymph node is palpable and non

tender. The lesion in the right foot is also tender. The lesion in the right foot is also

warty, fissured, rough, plaque type with warty, fissured, rough, plaque type with

mildmild

oozing, and is circumscribed. 3 of oozing, and is circumscribed. 3 of

inguinal lymph nodes of right side are inguinal lymph nodes of right side are

palpable and palpable and

non-tender, discrete. The lesions on non-tender, discrete. The lesions on

the back & right side of the trunk are the back & right side of the trunk are

papular, some with central necrosis papular, some with central necrosis

with features of few scar and eruption with features of few scar and eruption

of new lesions. All lesions mentioned of new lesions. All lesions mentioned

are painless, non-tender and non-itchy. are painless, non-tender and non-itchy.

His cough is mild & semi Productive. His cough is mild & semi Productive.

The patient is developing anorexia, The patient is developing anorexia,

weakness and undergoing gradual loss weakness and undergoing gradual loss

of weight of weight

but no evening rise of temp. or no night but no evening rise of temp. or no night

sweating or no H/O haemoptysis. He is also sweating or no H/O haemoptysis. He is also

mildly anaemic. He was treated with mildly anaemic. He was treated with

medicines like cephalosporines, flucloxacillin medicines like cephalosporines, flucloxacillin

and fluconazole.and fluconazole.

INVESTIGATIONINVESTIGATION

POSITIVE FINDINGS:

1. ESR : 50 mm in first hour.

2. Hb : 60%

3. M.T : 20mm in 72 hours.

4. X-ray : Chest P/view: Specific infection in right upper lung.

5. Skin biopsy for histopathology:

Dx : Tubercolosis verrucosa cutis (TVC).

OTHER FINDINGSOTHER FINDINGS

1.1. Sputum for AFB : NegativeSputum for AFB : Negative (3 consecutive (3 consecutive

days).days).

2.2. T.C. of WBC T.C. of WBC : : 9000/cumm.9000/cumm.

D.C. of WBCD.C. of WBC --

Neutrophil Neutrophil - - 60%.60%.

Lymphocyte Lymphocyte - - 36%.36%.

EosinophilEosinophil - - 02%.02%.

MonocyteMonocyte - - 02%.02%.

OTHER FINDINGS( Contd,)

3. Skin scraping for fungus:

M/E : No fungul elements found.

Culture: Growth of M.canis.

4. RBS : 88mg/dl.

DIAGNOSIS: DIAGNOSIS: Tuberculosis Tuberculosis verrucosa cutis verrucosa cutis with pulmonary with pulmonary tuberculosis with tuberculosis with papulo-necrotic papulo-necrotic tuberculid. tuberculid.

TREATMENTTREATMENT

Antitubercular drugs : Category - III Antitubercular drugs : Category - III