A 60-year-old woman presented to the Dermatology Department of Dokuz Eylül University Faculty of Medicine with complaints of hardened reddenings and inflammatory drainage on her right armpit, groin, and hips. These lesions appeared 2 months after a cholecystectomy operation, which had been performed 4 years ago, and showed unilateral progression. The patient had been treated unnecessarily with prednisolone (5 mg every other day) for 7 years because of arthralgia.

Dermatologic examination revealed erythematous induration, fistulas with central serous or purulent drainage, and conical-shaped scars on the regio axillaris dextra, regio abdominalis lateralis dextra, and regio lumbalis dextra. A linear operative scar with observable fistula located distally on the regio abdominalis lateralis dextra and another scar in a lateral position were observed. There were also abscesses, fistulas, and scars on the regio inguinalis and regio glutealis dextra (Fig. 1). Systemic examination was normal.


Figure 1. Clinical picture before treatment

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A tuberculin test showed erythema (9 cm) and induration in 72 h. Bacterial, mycotic, and tuberculous cultures of the vacuum and smear samples from the lesions and urine showed no reproduction.

A histopathologic examination of the biopsy material revealed nonspecific slight acanthosis, perivascular mononuclear cellular infiltration in the superficial dermis, and a dense mononuclear cellular infiltration in the subcutis.

The deoxyribonucleic acid obtained from the pus liquid by the phenol–chloroform method for the detection of mycobacterium tuberculosis with polymerase chain reaction was amplified using primers specific to microorganisms in the mycobacterium tuberculosis complex and also specific to the IS 6110 region. At the end of the molecular analysis, a product of amplification of 123 bp specific to mycobacterium tuberculosis was found.

The erythrocyte sedimentation rate was 92 mm/h. All other laboratory values were normal, including biochemical analysis, anti-human immunodeficiency virus, venereal disease research laboratory test, and rheumatoid factor. X-Ray and high-resolution computerized tomography examination of the chest, rectosigmoidoscopy, esophagus, stomach, duodenum, and small intestine passage X-ray examinations, and vaginal smear inspections, performed to investigate other organ tuberculosis, did not show any pathologic finding. The arthralgic complaints of the patient were assessed as degenerative arthrosis by considering the bone–joint X-ray examinations.

Isoniazid 300 mg/day and rifampicin 600 mg/day were given to the patient and, since the sixth week of administration, no drainage from fistulas was observed. At the end of 9 months of treatment, the lesions improved, with scar formation, and no new lesions were observed (Fig. 2). The improvement has continued in the 4 months following the completion of therapy.


Figure 2. Clinical picture after treatment

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