Cutaneous tuberculous abscess: a management problem.

A 66-year-old woman presented with a 6-week history of an indolent ulcerating lesion on the anterior chest wall. She had a past medical history of pulmonary tuberculosis which had been treated successfully in 1947. Biopsy of the ulcer showed granulomas and acid-fast bacilli. Cultures grew Mycobacterium tuberculosis, sensitive to all antituberculous drugs. After 7 months of treatment with isoniazid and rifampicin, there was little sign of healing. A sinogram showed a fistula leading into the plombage mass in the left upper lobe. Surgery to remove the plombage and excise the fistula was planned but was rejected by the patient as the risks of this operation are considerable. With continued antituberculous medication the discharge has reduced although the ulcer has not healed.