Photo Rounds

Sores in neck

A middle-aged man in Ethiopia sought care from a US medical team because he had draining sores in his left neck that had been there for months. He hadn’t had access to medical care, so the American family physician (FP) was the first doctor he’d seen. On exam, there were draining sinus tracts in the left neck with skin breakdown. The patient was afebrile.

What's your diagnosis?


The FP suspected scrofuloderma from tuberculosis (TB), and referred him to the local health department, where an advanced practice nurse ensured that he got a chest x-ray and an acid-fast bacillus (AFB) stain and culture. The chest x-ray was clear, but the AFB studies showed Mycobacterium tuberculosis. The patient was started on 4 TB drugs—isoniazid, rifampin, pyrazinamide, and ethambutol—while awaiting sensitivities.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith, M. Tuberculosis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:310-319.

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