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A previously well 6-year-old girl was referred to clinic with a 5-month history of an ulcerated lesion on her left forearm after sustaining an insect bite in Iraq, having recently emigrated to the UK. The lesion was initially painful and later became ulcerated, pruritic and inflamed. She previously received treatment with topical corticosteroid with no improvement. There were no systemic symptoms of fever, weight loss or night sweats. She had no significant medical history, no allergies or regular medication. Her vaccinations were up to date including BCG. There was no known exposure to tuberculosis and no other family members were affected.
Examination revealed a well-grown child with height and weight >25th centile. Systems examination was unremarkable with no lymphadenopathy or organomegaly. An ~2×3 cm erythematous plaque on the left dorsal forearm was noted (figure 1). Initial investigations revealed a normal Full Blood Count, Urea & Electrolytes and Liver Function Tests and negative tests for HIV and Hepatitis B & C. Mantoux was 0 mm, Quantiferon (IGRA) negative and chest X-ray was normal.
Which of the following …
Contributors All were involved in patient care. All were involved in manuscript design, serial drafts and approved final copy. SW provided expert external advice on patient management and reviewed final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.