GW Kim, et al Ann Dermatol Vol. 24, No 1, 2012 CASE REPORT http://dx.doi.org/10.5021/ad.2012.24.1.70 Delayed Diagnosis of Scrofuloderma Misdiagnosed as a Bacterial Abscess Gun-Wook Kim, M.S.1, Hyun-Je Park, M.S.1, Hoon-Soo Kim, M.S.1, Su-Han Kim, M.S.1, Hyun-Chang Ko, M.S.1,2, Byung-Soo Kim, Ph.D.1, Moon-Bum Kim, M.D., Ph.D.1,2, Eun-Kyung Sim3 1Department of Dermatology, School of Medicine, 2Medical Research Institute, Pusan National University, 3Department of Beauty Care, College of Health, Social Welfare and Education, Tongmyong University, Busan, Korea An 82-year-old woman presented with a four-month history of an ulcerative plaque overlying her left neck. This lesion had developed as a subcutaneous nodule, gradually increased in size, and evolved into ulcers. Before visiting our Dermatology clinic, the patient had been diagnosed as having a bacterial abscess, but treatments with antibiotics were unsuccessful. The presence of a purulent discharge and prominent ulceration caused further confusion as bacterial abscess, and radiologic evaluation on computed tomography also led to the possibilities of secondary lesions from an abscess or malignancy. However, the characteristic appearance of her lesion allowed us to discern cutaneous tuberculosis, especially scrofuloderma. Based on clinical examinations, staining for acid-fast bacilli, and positive findings of polymerase chain reaction, a quick diagnosis of scrofulo- derma was made. After that, she was treated successfully with anti-tuberculosis therapy and the ulcer healed. Our case highlights the problem of delayed diagnosis of scrofulo- derma presenting as a bacterial abscess. In conclusion, having a high index of suspicion is needed to diagnose cutaneous tuberculosis correctly. (Ann Dermatol 24(1) 70∼ 73, 2012) Received July 27, 2010, Revised October 7, 2010, Accepted for publication October 7, 2010 *This study was supported by a grant of the Korean Heath Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A070001). Corresponding author: Moon-Bum Kim, M.D., Ph.D., Department of Dermatology, School of Medicine, Pusan National University, 1-10 Ami-dong, Seo-gu, Busan 602-739, Korea. Tel: 82-51-240-7338, Fax: 82-51-245-9467, E-mail: drkmp@hanmail.net This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 70 Ann Dermatol -Keywords- Bacterial abscess, Scrofuloderma INTRODUCTION Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis, and it is often misdiagnosed because of a low index of suspicion1. Scrofuloderma results from the involvement and break-down of the skin overlying a tuberculous focus2. It begins as a painless subcutaneous nodule, called a cold abscess. With the continuous pro- pagation of an underlying infection, it is characterized by fistula formation and pus discharge from a lymph node. The cervical lymphatic chains are most frequently invol- ved2-4. Herein we report a case of scrofuloderma misdiag- nosed as a bacterial abscess and note the importance of maintaining a high level of awareness. CASE REPORT An 82-year-old woman presented with a four-month his- tory of an ulcerative plaque overlying her left neck. This lesion had developed as a subcutaneous nodule, which gradually increased in size and evolved into ulcers. The physical examination revealed a 3×5 cm, erythematous suppurative plaque on the surface of her neck. It was well- demarcated with elevated borders and deep undermined edges. The lesion also had central ulceration covered by a scant, cheesy, and purulent discharge (Fig. 1). There was no history of trauma. Systemic examination did not reveal any abnormalities, and there was no recent weight loss or night sweats. Before visiting our Dermatology clinic, the patient had been diagnosed as having a bacterial abscess and was