Three Cases of Primary Inoculation Tuberculosis as a Result of Illegal Acupuncture

Primary inoculation tuberculosis results from the direct inoculation of Mycobacterium tuberculosis into the skin of a person who has no natural or artificially acquired immunity to the organism. The pathogenesis requires a break in the skin from an abrasion or injury that allows entry of the tubercle bacilli. We report 3 cases of primary inoculation tuberculosis resulting from illegal acupuncture. Three patients over 70 years old presented with erythematous, ulcerative, indurated plaques on the back. Skin lesions had developed at the acupuncture sites 1 or 2 weeks after a session of acupuncture, which was intended to relieve back pain. An unlicensed, non-medically trained person conducted each session. The patients' past medical and family histories were unremarkable. Granulomatous inflammatory infiltration and acid-fast bacilli were observed histologically. M. tuberculosis was identified by mycobacterial culture and polymerase chain reaction. Nine months after the initiation of antituberculosis medication, skin lesions improved, and no evidence of recurrence or other organ involvement was observed at the 1-year follow-up visit.

A Case of Primary Inoculation Tuberculosis / 대한피부과학회지

Primary inoculation tuberculosis results from the inoculation of mycobacteria into the skin of a host not previously infected with tuberculosis. Tuberculous chancre and the affected regional lymph nodes constitute the tuberculous primary complex of the skin. A 21-year-old female visited our clinic with an erythematous, ulcerative, indurated plaque on her right upper eyelid. The skin lesion developed 2 months after bilateral upper blepharoplasty. The results of a skin biopsy with acid-fast bacilli staining and polymerase chain reaction were compatible with tuberculosis of the skin. After 9 months of antituberculosis chemotherapy, the skin lesion was improved.

A Case of Primary Inoculation Tuberculosis / 대한피부과학회지

Primary inoculation tuberculosis, also called tuberculosis chancre or tuberculosis primary complex, is the result of direct inoculation of M. tuberculosis in the skin of a host who has not been infected. A 33-year-old laboratory male presents with painless erythematous nodule and central ulcer on the left middle finger for 3 weeks. The skin lesion was developed after he punctured his finger with a needle containing M. tuberculosis. He had no history of tuberculosis. Histopathologic finding showed a wedged shaped abscess mixed with nuclear dust and eosinophils in the epidermis, and inflammatory cell infiltrations and caseation necrosis within the granuloma in the dermis. No bacillus was found in the lesion on AFB stain. We performed polymerase chain reaction with lesional tissue and obtained a positive result. So we diagnosed this case as a primary inoculation tuberculosis, and started antituberculosis medication. After 2 months of treatment, the erythema and ulcer improved. The patient completed a 9 months course of antituberculosis therapy without complication.