A previously healthy 10-year-old girl presented with ten days of low-grade fever and bilateral, multiple cervical lymphadenitis. The enlarged lymph nodes were discrete and mildly tender with normal overlying skin. Her fever and cervical lesions persisted despite treatment with ampicillin-sulbactam. The chest radiograph was normal. She had undergone Bacillus Calmette-Guérin (BCG) vaccination during the neonatal period.
A tuberculin skin test with 2 U of tuberculin partial purified derivative (PPD) RT 23 SSI, 2 T.U./0.1 mL, was injected intradermally over the middle third of the right volar forearm. Erythematous induration over the tuberculin injection site appeared 24 hours post-inoculation of tuberculin and peaked in size (25 × 22 mm) at 48 hours post-inoculation. The induration became tender, and the erythema worsened. The evolution of the lesions is shown in figure 1. The results of a…
