A 12-year-old girl presented with bilateral neck swelling with purulent discharge and skin ulceration of 3 months’ duration. She had a dry cough, low-grade fever, decreased appetite, and drenching night sweats, and she had lost a significant amount of weight. She had a global throbbing type of headache with occasional projectile vomiting of ingested matter starting 6 days before her visit. She had never been vaccinated and had no known contact with any person diagnosed with TB or any chronic cough. She had not received any treatment for the complaints prior to her current visit. She had no known medical problem, and her family and psychosocial history were unremarkable.
Examination
Her physical examination revealed a conscious, emaciated, and wasted child. Her vital signs at admission were pulse rate 80 beats/min, respiratory rate 20 breaths/min, blood pressure 90/60 mmHg, and axillary temperature 37.3 °C. Matted bilateral anterior cervical and postauricular lymphadenopathy with pus-draining sinus was noted. Crepitation over the anterior and posterior lower right chest, multiple skin ulcers with purulent drainage over the left lateral neck, anterior left chest, and left axilla were documented. Nuchal rigidity was positive, but no neurologic deficit was present.
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