Cutaneous tuberculosis presented by chest wall fistula formation

Tuberculosis is one of the world’s most debilitating diseases and it is at the top of six most prevalent and dangerous infectious diseases recognized by World Health Organization. Although one out of every three people in the world is affected by Mycobacterium tuberculosis, cutaneous infection is a relatively uncommon event. Here, we report a rare form of cutaneous tuberculosis presented by multiple fistulas over the anterior chest wall. Case report: This is a 50 year old insulin-dependent diabetic man from Afghanistan who was presented with a history of multiple skin lesions over his anterior chest wall for 3 months duration. At first, there was a single non-painful, small papular lesion, which became fistulized and developed purulent discharge, later. The patient was suspected as a case of cutaneous tuberculosis according to his nationality and prolonged history of unresponsiveness to outpatient antimicrobial treatment. This diagnosis approved based on skin biopsy result as it revealed multiple granulomas consisted of giant Langhans cells and the detection of numerous acid fast bacilli in the Ziehl-Neelsen staining of the skin secretions. Six weeks after treatment with anti-tuberculosis drugs, the signs of improvement were appeared and 6 months later there was no active fistula any more.

Cutaneous tuberculosis may present itself in uncommon forms such as fistula. It might be seen anywhere including chest wall. Therefore, this impression should be considered in patients with prolonged skin lesions and featured by fistula formation.