REPORT OF A CASE
A 48-year-old Chinese woman presented with a large plaque on her left shoulder. The plaque had developed at the age of 10 years, when she received a bacille Calmette-Guérin (BCG) vaccine on her left shoulder.The findings from her physical examination showed a 10× 12-cm erythematous and scaling firm plaque with a raised reddish border on the left deltoid area (Fig 1). A biopsy specimen was obtained from that site (Figs 2 and 3). The chest roentgenogram and the examination of the lymph nodes showed normal findings, and an acid-fast bacillus culture was negative.What is your diagnosis?
DIAGNOSIS:
BCG granuloma.
HISTOPATHOLOGIC FINDINGS
The hematoxylin-eosin-stained section of the patient's lesional skin revealed a dense tuberculoid granulomatous inflammation. The Fite stain on multiple serial sections revealed one acid-fast bacillus.
CLINICAL COURSE
Treatment with rifampin, izoniazide, and pyrazinamide was begun. At the