A 30-year-old male, who had undergone renal transplantation from a deceased donor on august 2017 with a stable graft function, presented with the complaints of fever and an ulcer on the right foot. On examination, the patient was malnourished and febrile, on inspection the ulcer was irregular approximately 3 x 2.5 x 3 cm in size, situated on the lateral aspect of dorsum of the right foot with yellowish white discharge, creamy in consistency. Pus for culture and sensitivity revealed the growth of Enterobacter spp which was sensitive to almost all the antibiotics used for Gram negative bacilli. Ziehl-Neelsen method of staining by using 25 % sulfuric acid as a decoloriser showed the presence of acid-fast bacilli in all smears. The pus sample was sent for Cartridge Based Nucleic Acid Amplification (Gene Xpert) test which was positive for Mycobacterium tuberculosis with negative rifampicin resistance.

Keywords: Rare presentation, skin tuberculosis, Mycobacterium, Gene Xpert.

1. Sriram K, Moffatt D, Stapledon R. Tuberculosis infection of the breast mistaken for granulomatous mastitis: a case report. Cases Journal 2008;1:273.
2. Fox W, Ellard GA, Mitchison DA. Studies on the treatment of tuberculosis undertaken by the British Medical Research Council tuberculosis units, 1946-1986, with relevant subsequent publications. Int J Tuberc Lung Dis. 1999;3(10 Suppl 2):S231–79.
3. Menzies D. Tuberculin skin testing. In: Reichman LB, Hershfield ES, editors. Tuberculosis: A comprehensive international approach. New York: Marcel Dekker; 2000. pp. 279–322.
4. TB INDIA 2013, Revised National TB control Programme Annual status report.
5. WHO global tuberculosis report 2014.
6. Centers of Disease Control and Prevention. Treatment of tuberculosis. MMWR. 2003;52 (RR-11):1-77.

Dr Priyadarshini Shanmugam

Professor & Head , Department of Microbiology, Chettinad Hospital & Research Institute