Photoclinic Diagnosis: Cutaneous Tuberculosis following BCG Vaccination

A14-year-old boy presented with a skin lesion on the lateral side of the upper right arm. He had the lesion since he received a dose of BCG vaccine eight years ago before entering primary school. The wound and crust that had developed after the BCG vaccination didn’t improve. In the following years, the involved area on the skin expanded and formed a plaque; the lesion caused no itching but had occasional mild exfoliation. During the eight years, different topical and oral antibiotics were prescribed for the patient that only reduced the surface inflammation of the lesion. On physical examination, a violet-red papule was observed on the lateral side of the upper right arm that was 8cm by 6cm in diameter without any discharge, tenderness, or pain. No axillary or cervical adenopathy was seen. The patient did not have history infectious or autoimmune disease.