Malakoplakia is an uncommon granulomatous infectious disease that is found primarily in the genitourinary tract, but may rarely involve the skin. We report a case of cutaneous malakoplakia in an HIV-positive patient diagnosed on the basis of Michaelis-Gutman bodies. The patient presented with ulcers, draining sinuses and tender papules and nodules mainly on perigenital area, buttocks and right thigh.
An 18-year-old male presented with a single round to oval well-defined irregular erythematous plaque 10 cm × 6 cm, with a verrucous surface, central atrophy, and crusting at the periphery on the right knee of one-year duration. The patient had received ATT (anti-tubercular treatment) twice in the past without any improvement. MGIT (mycobacteria growth indicator tube) and CBNAAT (Cartridge-based nucleic acid amplification test) were performed, and drug sensitivity testing was done, which led to a diagnosis of multidrug resistance (MDR) with a mixed pattern. The management of cutaneous tuberculosis (TB) is becoming difficult due to an increase in resistance to category-I ATT. Patients harboring MDR and extensively drug-resistant (XDR) strains present a fearsome challenge for the clinician. A cure is possible with early identification of resistance and the use of an appropriate regimen.
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