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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