American Journal of Pathology & Research
Open AccessA Case of Bifocal Scrofuloderma in an Immunocompetent Patient at the Dermatology Hospital of Bamako
Authors: Pierre Kitha, Tati Traoré, Mamoudou Diakité, Djeneba Kéita, Ismaïla Bamba, Koureissi Tall, Mamadou Gassama, Yamoussa Karabenta, Binta Guindo, Alimata Keita, Lamissa Cissé, Adama A Dicko, Ousmane Faye.
Abstract
Scrofuloderma is a Recognizer cutaneous manifestation of tuberculosis, typically arising from the direct extension of an underlying tuberculous focus, such as tuberculous lymphadenitis, to the overlying skin. Tuberculosis (TB) remains endemic in many developing countries and continues to pose a significant global health threat, particularly due to increased international migration. The clinical spectrum of cutaneous tuberculosis is broad and includes plaques (lupus vulgaris, cutaneous verrucous tuberculosis), macules and papules (acute miliary tuberculosis, papulonecrotic tuberculosis, scrofulous lichen), nodules and abscesses (Bazin’s erythema induratum, tuberculous gumma), as well as érosions and ulcers (tuberculous chancre, orificial tuberculosis, scrofuloderma).We report the case of a 32-year-old Malian male who presented with a three-months history of a continuously evolving ulceration of the neck. The lesion initially manifested as a painless nodule, which subsequently underwent suppuration and progressed to a painful erosion unresponsive to empirical antibiotic therapy. Clinical examination revealed an 8 × 3 cm oval-shaped ulcer with an erythematous base, well-demarcated borders, and slightly undermined, tender edges. The surrounding skin was erythematous. The lesion was located in the right supraclavicular fossa. One week later, a painful nodule developed in the ipsilateral axillary region, which subsequently ulcerated with purulent discharge. The remainder of the clinical examination was unremarkable. The Mantoux test was strongly positive (30 mm induration), and chest radiography was within normal limits. Bacterial culture confirmed the presence of Mycobacterium tuberculosis. Histopathological examination was not performed. A diagnosis of scrofuloderma was established based on clinical presentation and microbiological confirmation. The clinical presentation of a painless subcutaneous nodule evolving into abscess formation and subsequent fistulization should raise strong suspicion of scrofuloderma. In tropical settings, the identification of Mycobacterium tuberculosis should be prioritized before considering alternative etiologies.
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