Scrofuloderma and Miliary Tuberculosis in a 27-Year-Old Nurse

A previously healthy 26-year-old female nurse presented with fever, diaphoresis, and occasional cough for over two months. She visited the emergency department several times and never had a correct diagnosis. Eventually, she presented to the emergency department of the ISSSTE General Hospital of Querétaro and was admitted to the Internal Medicine service. On physical examination, she had a non-painful, mobile, well-defined, and indurated nodule in the left cervical region, approximately 20 mm in diameter. The skin had erythematous-violaceous discoloration on top of the nodule with two central ulcerations and discrete seropurulent discharge when applying pressure. The nodule was biopsied. Histologic report identified caseous necrosis, and, simultaneously, chest X-ray and chest CT scan findings of miliary tuberculosis. Subsequently, polymerase chain reaction identification of Mycobacterium tuberculosis confirmed the diagnosis of lymph node tuberculosis with contiguous scrofuloderma and pulmonary miliary tuberculosis. After 12 months of treatment, clinical recovery was accomplished.