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Isolated skin ulcers due to Mycobacterium tuberculosis in a renal allograft recipient

Abstract

Background A 27-year-old male renal allograft recipient presented to hospital with isolated skin ulcers on both lower limbs. At presentation, he also had a low-grade continuous fever, malaise and anorexia.

Investigations Physical examination, laboratory studies, histopathological examination of tissue biopsy samples from the ulcer edges and ulcer floor, culture of the biopsy tissue, chest radiograph, bone marrow biopsy, abdominal ultrasound, tuberculin skin test and examination of three early morning samples of gastric juice and urine for acid-fast bacilli.

Diagnosis Isolated cutaneous ulcers caused by Mycobacterium tuberculosis.

Management Four-drug antituberculosis therapy with pyrazinamide, of loxacin, ethambutol and isoniazid.

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Figure 1: Photograph showing one of the tuberculous skin ulcers at presentation.
Figure 2: Photomicrograph of biopsy tissue from the ulcer edge.
Figure 3: Photomicrograph of biopsy tissue from the ulcer floor.
Figure 4: Photomicrograph of biopsy tissue from the ulcer floor.
Figure 5: Photograph showing paradoxical expansion of cutaneous tuberculosis.

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Correspondence to Kaligotla V Dakshinamurty.

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Ram, R., Uppin, S., Swarnalatha, G. et al. Isolated skin ulcers due to Mycobacterium tuberculosis in a renal allograft recipient. Nat Rev Nephrol 3, 688–693 (2007). https://doi.org/10.1038/ncpneph0661

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