{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:02:12Z","timestamp":1780048932772,"version":"3.53.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cutaneous tuberculosis (TB) is a rare manifestation of extrapulmonary TB, accounting for only 1\u20131.5% of cases. Among its various forms, cutaneous miliary TB is exceptionally uncommon and often presents with nonspecific clinical features. This makes early diagnosis challenging, especially in individuals who are immunocompromised. We report the case of a 67-year-old woman who presented with a 6-month history of multiple painful, nonhealing ulcers over the mons pubis, perivulvar area and left upper arm. Despite multiple courses of antibiotics, there was no improvement. Clinical examination revealed multiple well-defined ulcers with yellowish discharge. The patient had no history of bacille Calmette\u2013Gu\u00e9rin vaccination. Tissue GeneXpert analysis from the ulcer confirmed Mycobacterium tuberculosis, and chest radiography revealed bilateral pulmonary nodules consistent with miliary TB. Imaging of the spine also showed features of spinal TB. The patient was diagnosed with miliary TB and was initiated on standard antitubercular therapy. Significant clinical improvement was noted within 1 month of treatment. This case highlights the importance of considering cutaneous TB, including its rare miliary form, in the differential diagnosis of chronic nonhealing ulcers, particularly in endemic areas or in patients with systemic symptoms. Early diagnosis and appropriate therapy are crucial for favourable outcomes.<\/jats:p>","DOI":"10.1093\/skinhd\/vzag011","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:08:14Z","timestamp":1769515694000},"page":"318-321","source":"Crossref","is-referenced-by-count":0,"title":["The ulcer that would not heal: a rare cutaneous clue to miliary tuberculosis"],"prefix":"10.1093","volume":"6","author":[{"given":"Elisha","family":"Shrestha","sequence":"first","affiliation":[{"name":"Department of Dermatology, Dhulikhel Hospital, Kathmandu University Hospital , Kathmandu ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Tamang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Dhulikhel Hospital, Kathmandu University Hospital , Kathmandu ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namrata","family":"Pradhan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Cutis Care , Kathmandu ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjan Kumar","family":"Sah","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Dhulikhel Hospital, Kathmandu University Hospital , Kathmandu ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binay","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Dhulikhel Hospital, Kathmandu University Hospital , Kathmandu ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupa","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Dhulikhel Hospital, Kathmandu University Hospital , Kathmandu ,","place":["Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"2026052905165871600_vzag011-B1","doi-asserted-by":"crossref","DOI":"10.54394\/CJQU6666","volume-title":"Global Tuberculosis Report 2024","author":"World Health Organization","year":"2024"},{"key":"2026052905165871600_vzag011-B2","first-page":"1761","article-title":"Extrapulmonary tuberculosis: an overview","volume":"72","author":"Golden","year":"2005","journal-title":"Am Fam Physician"},{"key":"2026052905165871600_vzag011-B3","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.jaad.2021.12.063","article-title":"Cutaneous tuberculosis. Part I: pathogenesis, classification, and clinical features","volume":"89","author":"Kaul","year":"2023","journal-title":"J Am Acad Dermatol"},{"key":"2026052905165871600_vzag011-B4","doi-asserted-by":"crossref","first-page":"920","DOI":"10.3390\/pathogens12070920","article-title":"Cutaneous manifestations of Mycobacterium tuberculosis: a literature review","volume":"12","author":"Nguyen","year":"2023","journal-title":"Pathogens"},{"key":"2026052905165871600_vzag011-B5","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.abd.2021.07.004","article-title":"Cutaneous tuberculosis: epidemiological, clinical, diagnostic and therapeutic update","volume":"97","author":"Brito","year":"2022","journal-title":"An Bras Dermatol"},{"key":"2026052905165871600_vzag011-B6","first-page":"19","article-title":"Cutaneous tuberculosis: a practical case report and review for the dermatologist","volume":"2","author":"Frankel","year":"2009","journal-title":"J Clin Aesthet Dermatol"},{"key":"2026052905165871600_vzag011-B7","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2165\/00128071-200203050-00004","article-title":"Cutaneous tuberculosis: diagnosis and treatment","volume":"3","author":"Barbagallo","year":"2002","journal-title":"Am J Clin Dermatol"},{"key":"2026052905165871600_vzag011-B8","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.clindermatol.2006.05.005","article-title":"Cutaneous tuberculosis","volume":"25","author":"Bravo","year":"2007","journal-title":"Clin Dermatol"},{"key":"2026052905165871600_vzag011-B9","first-page":"494","article-title":"Cutaneous tuberculosis: a twenty-year prospective study","volume":"3","author":"Kumar","year":"1999","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026052905165871600_vzag011-B10","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1590\/abd1806-4841.20142334","article-title":"Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinical aspects\u2014part I","volume":"89","author":"Santos","year":"2014","journal-title":"An Bras Dermatol"},{"key":"2026052905165871600_vzag011-B11","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.4187\/respcare.01107","article-title":"Skin ulcers: a sign of disseminated tuberculosis","volume":"56","author":"Tekbas","year":"2011","journal-title":"Respir Care"},{"key":"2026052905165871600_vzag011-B12","doi-asserted-by":"crossref","first-page":"7201973","DOI":"10.1155\/2018\/7201973","article-title":"Cutaneous tuberculosis: clinicopathologic arrays and diagnostic challenges","volume":"2018","author":"Khadka","year":"2018","journal-title":"Dermatol Res Pract"},{"key":"2026052905165871600_vzag011-B13","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.tube.2014.12.006","article-title":"Cutaneous tuberculosis overview and current treatment regimens","volume":"95","author":"van Zyl","year":"2015","journal-title":"Tuberculosis (Edinb)"},{"key":"2026052905165871600_vzag011-B14","volume-title":"Treatment of Tuberculosis: Guidelines for National Programmes","author":"World Health Organization","year":"2023","edition":"6th edn"},{"key":"2026052905165871600_vzag011-B15","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/BLO.0b013e318065b7c3","article-title":"Tuberculosis of the spine: a review","volume":"460","author":"Jain","year":"2007","journal-title":"Clin Orthop Relat Res"}],"container-title":["Skin Health and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/skinhd\/article-pdf\/6\/3\/318\/67725155\/vzag011.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/skinhd\/article-pdf\/6\/3\/318\/67725155\/vzag011.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T09:17:09Z","timestamp":1780046229000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/skinhd\/article\/6\/3\/318\/8572458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":15,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,4,2]]},"published-print":{"date-parts":[[2026,5,29]]}},"URL":"https:\/\/doi.org\/10.1093\/skinhd\/vzag011","relation":{},"ISSN":["2690-442X"],"issn-type":[{"value":"2690-442X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,4,2]]}}}