Clinical picture

Primary cutaneous tuberculosis in an elderly man A 95-year-old man presented with a 1-month history of enlarging painful ulcerative plaque on the left chest wall. Skin examination showed a 5 3 cm ulcer with central necrosis and purulent discharge. The ulcer was neither warm nor swollen at periph-ery (Figure 1A). He recalled that initially it was a tiny papule that subsequently enlarged and became ulcer. He had been otherwise healthy and there were no associated constitutional symptoms such as fever, malaise, cough, lymphadenopathy or recent weight loss. Initial bacterial culture yielded no growth. Skin biopsy showed granulomatous inflammation with positive acid-fast bacilli (Figure 1B). Chest X-ray did not show evidence o