Delayed Diagnosis of Scrofuloderma Misdiagnosed as a Bacterial Abscess tant bacterial infection frequently occur, preventing early diagnosis of tuberculosis if not suspected1,7. Therefore, a high index of suspicion is needed for the prompt diagnosis and management of this uncommon skin disorder. When a therapeutic trial is undertaken in a case of cuta- neous tuberculosis, 6 weeks of therapy with four drugs appears adequate to prove (or disprove) the diagnosis. REFERENCES 1. Lantos G, Fisher BK, Contreras M. Tuberculous ulcer of the skin. J Am Acad Dermatol 1988;19:1067-1072. 2. Tappeiner G. Tuberculosis and infections with atypical my- cobacteria. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick's dermatology in general medicine. 7th ed. New York: McGraw-Hill Medical, 2008:1768-1778. 3. Barbagallo J, Tager P, Ingleton R, Hirsch RJ, Weinberg JM. Cutaneous tuberculosis: diagnosis and treatment. Am J Clin Dermatol 2002;3:319-328. 4. Sehgal VN, Wagh SA. Cutaneous tuberculosis. Current con- cepts. Int J Dermatol 1990;29:237-252. 5. Kivanç-Altunay I, Baysal Z, Ekmekçi TR, Köslü A. Incidence of cutaneous tuberculosis in patients with organ tuberculo- sis. Int J Dermatol 2003;42:197-200. 6. Yates VM, Ormerod LP. Cutaneous tuberculosis in Black- burn district (U.K.): a 15-year prospective series, 1981-95. Br J Dermatol 1997;136:483-489. 7. Tan WP, Tang MB, Tan HH. Scrofuloderma from the acro- mioclavicular joint presenting as a chronic ulcer in an immu- nocompetent host. Singapore Med J 2007;48:e243-245. 8. Hsiao PF, Tzen CY, Chen HC, Su HY. Polymerase chain reaction based detection of Mycobacterium tuberculosis in tissues showing granulomatous inflammation without demon- strable acid-fast bacilli. Int J Dermatol 2003;42:281-286. 9. Vashisht P, Sahoo B, Khurana N, Reddy BS. Cutaneous tuberculosis in children and adolescents: a clinicohistolo- gical study. J Eur Acad Dermatol Venereol 2007;21:40-47. 10. Handog EB, Gabriel TG, Pineda RT. Management of cuta- neous tuberculosis. Dermatol Ther 2008;21:154-161. 11. Ramam M, Mittal R, Ramesh V. How soon does cutaneous tuberculosis respond to treatment? Implications for a thera- peutic test of diagnosis. Int J Dermatol 2005;44:121-124. Vol. 24, No. 1, 2012 73