Ann Dermatol.  2010 Aug;22(3):341-345. 10.5021/ad.2010.22.3.341.

Three Cases of Primary Inoculation Tuberculosis as a Result of Illegal Acupuncture

• Kim JK
• Kim TY
• Kim DH
• Yoon MS

• KMID: 2265373
• DOI: http://doi.org/10.5021/ad.2010.22.3.341

Abstract

Primary inoculation tuberculosis results from the direct inoculation of Mycobacterium tuberculosis into the skin of a person who has no natural or artificially acquired immunity to the organism. The pathogenesis requires a break in the skin from an abrasion or injury that allows entry of the tubercle bacilli. We report 3 cases of primary inoculation tuberculosis resulting from illegal acupuncture. Three patients over 70 years old presented with erythematous, ulcerative, indurated plaques on the back. Skin lesions had developed at the acupuncture sites 1 or 2 weeks after a session of acupuncture, which was intended to relieve back pain. An unlicensed, non-medically trained person conducted each session. The patients' past medical and family histories were unremarkable. Granulomatous inflammatory infiltration and acid-fast bacilli were observed histologically. M. tuberculosis was identified by mycobacterial culture and polymerase chain reaction. Nine months after the initiation of antituberculosis medication, skin lesions improved, and no evidence of recurrence or other organ involvement was observed at the 1-year follow-up visit.

Keyword

Acupuncture; Primary inoculation tuberculosis

MeSH Terms

Acupuncture
Adaptive Immunity
Back Pain
Follow-Up Studies
Humans
Mycobacterium tuberculosis
Polymerase Chain Reaction
Recurrence
Skin
Tuberculosis
Ulcer

Figure

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  Fig. 1 (A) Indurated, erythematous plaque on back in case 1. (B) The skin lesions improved after treatment with antituberculosis medication for 9 months in case 1. (C, D) Erythematous plaques with purulent discharge on shoulder and back in case 2. (E) Erythematous plaques and ulcers with purulent pseudomembrane on lower back in case 3. (F) After 9 months of treatment, the skin lesions improved in case 3.

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  Fig. 2 (A) Diffuse dermal infiltration composed of lympho histiocytes and abundant neutrophils with necrosis of dermal collagen fibers and focal aggregation of numerous acid-fast bacilli identified by Ziehl-Neelsen stain (inset) in case 1 (H&E stain, ×100, Inset: Ziehl-Neelsen stain, ×400). (B, C) Deep dermal abscess with inflammatory cellular infiltration and foreign body reaction in case 2 and case 3, respectively (H&E stain, ×100).

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  Fig. 3 Polymerase chain reaction for Mycobacterium tuberculosis in formalin-fixed, paraffin-embedded skin biopsy specimen showed a positive band of 304 bp in case 1 (M: molecular weight marker, P: positive control, 1, 2, 3: cases 1, 2, 3, N: negative control).

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  Fig. 4 A yellowish, cream-colored colony on Ogawa's medium, 2 months after inoculation.

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