A painless pigmented pinna lesion

Abstract

A 15-year-old boy presented with a 2-month history of a painless lesion on the right earlobe and multiple neck lumps. He had emigrated from Pakistan 4 years earlier and had received the Bacillus Calmette-Guérin (BCG) vaccine at birth. He denied systemic or respiratory symptoms. On examination, a 14 mm soft painless pigmented lesion on the pinna was noted (figure 1). Multiple discreet lymph nodes were palpable on either side of the neck. A Mantoux test was positive but a chest x-ray was unremarkable. Excision biopsy for histology and culture from the ear and representative lymph node showed multiple caseating granulomata with acid-fast bacilli (AFB) on Ziehl-Neelsen staining. Subsequent culture grew Mycobacterium tuberculosis, which was treated with a 6-month course of antituberculosis treatment, to good effect.