2. SALIENT FEATURE Mr. Sharif, aged 40 Years, hailed from Mymensingh Jail, came to MMCH on 06-04-06 with the complaints of: 1. One rough surfaced elevation of skin in the left axilla for 3 ½ years and another same type of elevation of skin on the right foot for 2½ years.

3. 2.Numerous small elevations of skin over the back and right side of the trunk for 4 months. 3.Mild cough for 6 months. On Examination – The lesion in the left axilla reveals warty, fissured, rough, plaque type On Examination – The lesion in the left axilla reveals warty, fissured, rough, plaque type

4. lesion extending from anterior axillary fold in an irregular and linear fashion up to the posterior axillary fold. The apical axillary lymph node is palpable and non tender. The lesion in the right foot is also warty, fissured, rough, plaque type with mild oozing, and is circumscribed. 3 of inguinal lymph nodes of right side are palpable and

5. non-tender, discrete. The lesions on the back & right side of the trunk are papular, some with central necrosis with features of few scar and eruption of new lesions. All lesions mentioned are painless, non-tender and non-itchy. His cough is mild & semi Productive. The patient is developing anorexia, weakness and undergoing gradual loss of weight

6. but no evening rise of temp. or no night sweating or no H/O haemoptysis. He is also mildly anaemic. He was treated with medicines like cephalosporines, flucloxacillin and fluconazole.

10. INVESTIGATION POSITIVE FINDINGS: 1.ESR : 50 mm in first hour. 2.Hb: 60% 3.M.T: 20mm in 72 hours. 4.X-ray: Chest P/view: Specific infection in right upper lung. 5.Skin biopsy for histopathology: Dx : Tubercolosis verrucosa cutis (TVC).

11. OTHER FINDINGS 1.Sputum for AFB : Negative (3 consecutive days). 2.T.C. of WBC : 9000/cumm. D.C. of WBC- Neutrophil - 60%. Lymphocyte - 36%. Eosinophil- 02%. Monocyte- 02%.

12. OTHER FINDINGS( Contd,) 3.Skin scraping for fungus: M/E : No fungul elements found. Culture: Growth of M.canis. 4.RBS : 88mg/dl.

13. DIAGNOSIS: Tuberculosis verrucosa cutis with pulmonary tuberculosis with papulo-necrotic tuberculid.

14. TREATMENT Antitubercular drugs : Category - III