Cutaneous forms of Mycobacterium tuberculosis infection include primary inoculation tuberculosis (tuberculous complex), scrofuloderma, lupus vulgaris, miliary tuberculosis, tuberculosis verrucosa cutis, and the tuberculids.1,2 By definition, the primary tuberculous complex represents an infection in a host who had had no previous infection with the tubercle bacillus.1 We recently treated a patient who had a lesion on her hand that, on gross and histologic examination, resembled a primary tuberculous complex, but, on clinical examination, seemed to represent secondary spread by direct cutaneous inoculation from the patient's own draining sinus.
Report of a Case
A 65-year-old woman experienced mild malaise along with clear drainage from a small lesion on her back. During the next few months, several small nodules, two of which subsequently ulcerated, developed on her left hand. There was pain and decreased visual acuity in her left eye. She sought an ophthalmologic evaluation of her condition. Physical examination showed
Cohn JR, Harris MS. Cutaneous Autoinoculation by Mycobacterium tuberculosis. Arch Dermatol. 1982;118(5):363-365. doi:10.1001/archderm.1982.01650170077033