Erythematous rash

A 63-year-old woman presented with an acute, painful erythematous rash on the right side of her abdomen for 7 days. She had a history of pulmonary tuberculosis for 20 years and took antituberculosis medication for 1 year at that time. On physical examination, ill-defined, tender, erythematous plaques were seen. There was no regional lymphadenopathy. Laboratory findings revealed a white blood cell count of 10 600 cells/mm. (normal, 4000±10 000 cells/mm) blood glucose level AC/PC 2 h, 238/319 mg/dL, (normal, AC 70±110 mg d/L, PC 2h 70±140 mg d/L) and glycosuria of 31, 1000 mg/dL (normal, 0 mg d/L). Chest X-ray showed no active pulmonary parenchymal lesion compared to an earlier film. Sputum examination for acid-fast bacilli was negative on three consecutive occasions. PPD skin test was negative. Antibiotic therapy with amikacin (500 mg, i.v. twice daily) and clindamycin (900 mg, i.v. twice daily) was started for presumed bacterial cellulitis, but there was no improvement. Skin biopsy from the abdomen revealed perivascular lymphohistiocytic infiltrates, fat necrosis and numerous granulomas with central caseating necrosis. Ziehl-Neelsen stain was positive for acid-fast microorganisms. The sample culture & Polymerase chain reaction of the skin biopsy specimen was positive.