Primary Inoculation Tuberculosis of the Skin

Subsequent to an autopsy of a tuberculotic cadaver, a pathology resident presented with a painless paronychia and axillary adenopathy after surgical incision and broad-spectrum antibiotics had failed to improve his condition. Demonstration by culture of Mycobacterium tuberculosis var hominis, positive smears, and findings of acid-fast organisms in a skin biopsy specimen proved the diagnosis of tuberculosis. Conversion of a previously negative skin test permitted the diagnosis of primary inoculation tuberculosis of the skin. The disease responded well to treatment with isoniazid, rifampin, and pyridoxine hydrochloride.