Bilateral scrofuloderma: An incessant entity

Scrofuloderma is most common presentation of cutaneous tuberculosis in India. A 15-years-old immunocompetent male presented with bilateral cervical necrotising lesions and was treated with ATTx9 months, without improvement. Patient was diagnosed with scrofuloderma and ZN staining revealed 2+acid-fast bacilli. Cartridge-based nucleic acid amplification test showed rifampicin resistance. Patient was initiated on shorter regimen, but deferred treatment owing to technical portal problems. After 3 months, neck swelling had enlarged and he was started on multi-drug regimen x24 months. This underlines requisite to consider scrofuloderma in differentials of bilateral cervical lesions and to periodically monitor compliance to prevent subsequent emergence of resistance.