During my time in the TB clinic earlier this week I had the opportunity to see a very interesting case involving a patient at follow-up. Initially, the patient presented with large masses on her ears with no apparent cause. As an immigrant to Canada from a country with cases of leprosy, the patient was worked up for a variety of potential causes including both leprosy and also TB.
I found this to be an incredibly interesting case as I had never seen any cutaneous manifestations of TB before. Cutaneous lesions are relatively uncommon manifestations of TB and occur in only 1-2% of infected patients. The lesion appeared to be large, verrucous nodules, almost similar to keloids. In learning about TB in class, we are taught of extrapulmonary TB. However, I was amazed at how the physicians were able to come to a differential diagnosis including TB based on this appearance. I also found the case interesting as the treatment for potential leprosy would be counterproductive in treating TB, and vice versa. The physician decided to treat the patient empirically (despite all tests for M. tuberculosis being negative) with great improvement of the lesions at her follow-up visit. From this encounter I learned how insidious TB can be and to be reminded to always keep it on my differential.
-JD
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