CUTANEOUS TUBERCULOUS ABSCESS - A MANAGEMENT PROBLEM

A 66-year-old woman presented with a 6-week history of an indolent ulc erating lesion on the anterior chest wall. She had a past medical hist ory of pulmonary tuberculosis which had been treated successfully in 1 947, Biopsy of the ulcer showed granulomas and acid-fast bacilli. Cult ures grew Mycobacterium tuberculosis, sensitive to all antituberculous drugs, After 7 months of treatment with isoniazid and rifampicin, the re was little sign of healing. A sinogram showed a fistula leading int o the plombage mass in the left upper lobe. Surgery to remove the plom bage and excise the fistula was planned but was rejected by the patien t as the risks of this operation are considerable. With continued anti tuberculous medication the discharge has reduced although the ulcer ha s not healed.