Abstract
A 67-year-old woman had undergone hemodialysis for two years because of diabetic renal failure. She had noticed some subcutaneous nodules on her inguinal regions six months previously, and the number of nodules had increased. On the first consultation, acid-fast bacilli were observed in the pus from the absess, and PCR and cultivation of the bacilli in egg-based medium showed Mycobacterium tuberculosis. The histopathological findings from the one of the nodules revealed caseous necrosis, inflammatory infiltration with lymphocytes, and a few Langhansʼs giant cells surrounding the necrosis. No tuberculous granuloma was observed. Triple anti-tuberculosis chemotherapy (RFP 300 mg/day, INH 300 mg/day, EB 500 mg/every other day) produced a complete remission. Skin biopsies were perfomed periodically 3 times after the treatment. Two months after therapy, a lot of Langhansʼs giant cells were observed. but the tuberculous granuloma was poorly formed. Four months and 7 months later, much tuberculous granuloma was observed, As the number of scrofuloderma cases is increasing in the elderly, we consider that it is important to test for not only common bacteria but also mycobacteria in the subcutaneous abcesses found on immuno-suppressive patients.
