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Endgames Case Review

Chronic suppurative skin lesions in a young woman

BMJ 2021; 373 doi: (Published 21 April 2021) Cite this as: BMJ 2021;373:n797
  1. Paul Arkell, specialist registrar in infectious diseases and microbiology13,
  2. Tanizio E Florindo, doctor in internal medicine1,
  3. Rob Baird, consultant in infectious diseases and microbiology4,
  4. Christopher Babua, consultant in internal medicine15
  1. 1Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor Leste
  2. 2STONG-TL Project, Menzies School of Health Research, Darwin, Australia
  3. 3Department of Infectious Diseases, Imperial College London, London, UK
  4. 4Territory Pathology, Darwin, Australia
  5. 5Royal Australasian College of Surgeons, Melbourne, Australia
  1. Correspondence to: P Arkell paularkell{at}

A woman in her early 20s presented with skin ulcers and swellings on her neck, right axilla, and chest, which had gradually worsened over six months. Her presentation was delayed because she was anxious about receiving medical care, and travel to the clinic was difficult and costly.

The lesions began as painful swellings, which later ulcerated and produced a cream coloured discharge. The patient had no fever or respiratory symptoms. Ten years earlier she had received eight weeks of empirical antituberculosis treatment for similar skin eruptions. This had resulted in some improvement, but she had stopped treatment early because her family thought that a longer course was not necessary.

On examination she weighed 35 kg, with a body mass index of 16.6 kg/m2, and muscle wasting was evident. She had no pallor or jaundice, and vital signs were within normal limits. The patient had bilateral …

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