Update (On Derm round 1)

This lady presented with granulomatous lesions over the face of 6 months duration (Derm round 11). She had a skin biopsy done and was empirically covered with T. EES (Erythromycin) 400mg BD for two weeks.

Her biopsy was later reported as chronic granulomatous lesion, suggestive of atypical mycobateria infection.

On two weeks follow-up, surprisingly, the lesions had flattened >50% with areas of scaling and crusting.

We extended another two weeks of EES and will be discussing her HPE in the next combine meeting. KIV may need to start on anti-TB if indicated.

Derm round 11

65 years old lady presented with the above lesions over the face of 6 months duration.

What are these lesions?
? Granuloma faciale.

We did a biopsy and the result came back as such:
" Multiple sections showed skin tissue with marked granulomatous lesion in the dermis consists of aggregates of epitheliod cells, lymphocytes and some multinucleated giant cells. No obvious central caseous necrosis seen. No atypical cell seen. No evidence of malignancy seen. Stains for fungal, AFB and leprae bacilli are negative. Diagnosis: Chronic granulomatous lesion, suggestive of atypical mycobacterial infection."

Hmn, rather non-specific isn't is?
What features actually point to atypical mycobacterial infection, huh?
Anyway, we will discuss the case in the HPE discussion session with the pathologists cm.