title: Delayed diagnosis of scrofuloderma misdiagnosed as a bacterial abscess.
abstract: An 82-year-old woman presented with a four-month history of an ulcerative plaque overlying her left neck. This lesion had developed as a subcutaneous nodule, gradually increased in size, and evolved into ulcers. Before visiting our Dermatology clinic, the patient had been diagnosed as having a bacterial abscess, but treatments with antibiotics were unsuccessful. The presence of a purulent discharge and prominent ulceration caused further confusion as bacterial abscess, and radiologic evaluation on computed tomography also led to the possibilities of secondary lesions from an abscess or malignancy. However, the characteristic appearance of her lesion allowed us to discern cutaneous tuberculosis, especially scrofuloderma. Based on clinical examinations, staining for acid-fast bacilli, and positive findings of polymerase chain reaction, a quick diagnosis of scrofuloderma was made. After that, she was treated successfully with anti-tuberculosis therapy and the ulcer healed. Our case highlights the problem of delayed diagnosis of scrofuloderma presenting as a bacterial abscess. In conclusion, having a high index of suspicion is needed to diagnose cutaneous tuberculosis correctly.
authors.affiliation: Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.
authors.forename: Gun-Wook
authors.initials: GW
authors.lastname: Kim
authors.forename: Hyun-Je
authors.initials: HJ
authors.lastname: Park
authors.forename: Hoon-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Su-Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Hyun-Chang
authors.initials: HC
authors.lastname: Ko
authors.forename: Byung-Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Moon-Bum
authors.initials: MB
authors.lastname: Kim
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Sim