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| Fig. 30.2 Primary-inoculation tuberculosis presenting as an eroded papule. The patient was a microbiologist in a hospital laboratory, and this was probably an accidental inoculation. (Courtesy of James E. Fitzpatrick, MD.) |
Primary tuberculosis may occur in any age group, but is most common in children up to 4 years of age and young adults. The face, mucous membranes (conjunctiva and oral mucosa), and lower extremity are the usual sites of infection. A tuberculous chancre develops 2 to 4 weeks after inoculation and presents as a painless, firm, red-brown papule/ nodule, which slowly enlarges, eventually eroding to form a sharply demarcated ulcer (Fig. 30-2). Regional, hard, nonpainful lymphadenopathy occurs 3 to 8 weeks after infection. The combination of the tuberculous chancre and lymphadenopathy is analogous to the Ghon complex in the lungs. The purified protein derivative (PPD) may initially be negative and diagnosis is confirmed by culture.
