Ulcers of the face and neck in a woman with pulmonary tuberculosis: presentation of a clinical case

Introduction: Tuberculosis (TB), which is endemic in developing countries, is an important public health problem. Cutaneous TB (CT) represents 1.5% of all TB cases and is considered to be a re-emerging pathology in developing countries due to co-infections with HIV, multidrug-resistant TB, a shortage of health facilities with appropriate diagnostic equipment, reduced access to treatment, and poor treatment compliance among patients who often resort to traditional medicine. Case report: This report describes the case of a 70 year-old woman who attended the outpatients department of the Italian Dermatological Centre (IDC) in Mekelle, the capital city of Tigray (Northern Ethiopia), complaining of the appearance of two ulcers on her face and neck. The patient had a history of pulmonary TB, with her initial systemic treatment ceased after 1 month. Cytological examination of a needle aspiration from the neck lesion showed a non-specific bacterial superinfection. No acid-fast bacilli were found on Ziehl-Nielsen staining. On the basis of clinical suspicion of CT, it was decided to avoid biopsy for histology and culture and to immediately start anti-tubercular treatment. A significant improvement of the cutaneous lesions was noted after approximately 40 days. Conclusion: Currently, the diagnosis of CT is based on careful clinical and histopathological correlation. The standard diagnostic approach is to biopsy for Ziehl-Nielsen stain, culture and histology. However, in rural areas of DC where diagnostic methods may not be available and advanced stages of disease such as CT are likely to be encountered, after the use of the most effective diagnostic tests available, empirical treatment on the basis of medical history and physical examination is suggested. Appropriate training of healthcare workers and public health education programs encouraging early presentation and improved patient treatment compliance are additional important preventative strategies.