title: Tuberculous granuloma: a rare cause of a non-healing ulcer.
abstract: A 78-year-old woman on ciclosporin for aplastic anaemia presented to her general practitioner with a 2 cm cystic swelling on the right side of her forehead. After a period of 8 months the lesion ruptured and, despite good wound care, failed to heal over a period of seven further months. Imaging demonstrated an invasive process and a biopsy was taken, which showed granulomatous inflammation that stained positively for mycobacteria. Further investigation with cross-sectional imaging revealed no other sites of disease. The only history of exposure to tuberculosis was 64 years prior to presentation. Differential diagnoses of mycetoma, autoimmune disease and non-tuberculous mycobacterial infection were considered, but culture confirmed tuberculosis. This case demonstrates an unusual presentation of isolated cutaneous tuberculosis in a patient with suppressed immune function.
authors.affiliation: MDHU Derriford, Plymouth, Devon, UK.
authors.forename: George Edward Alexander
authors.initials: GE
authors.lastname: Graham
authors.affiliation: Armada Surgery, Plymouth, Devon, UK.
authors.forename: Rupert
authors.initials: R
authors.lastname: Jones
authors.affiliation: Derriford Hospital, Plymouth, Devon, UK.
authors.forename: David
authors.initials: D
authors.lastname: Derry
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D006099:Granuloma / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D007249:Inflammation / Q000382:microbiology; D009161:Mycobacterium; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D014456:Ulcer / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D014945:Wound Healing