Lumps and bumps.

Over the course of 6 months, an 8-year-old boy presented with cutaneous lumps: a postauricular lump, a fluctuant scalp lump, a lump adjacent to his shin, and a firm chest wall lump. Although he was born in the UK, his family were from Kenya and had visited there after the symptoms started. After multiple courses of antibiotics and antifungals with no improvement, he underwent ultrasound scanning that showed erosion of bone under the lumps and computed tomographic (CT) scanning which showed tibial osteomyelitis. A biopsy of the chest wall lump showed granulomatous inflammation, and pus was extracted from the shin lump that was negative on Ziehl-Neilsen and Gram staining. A tuberculin skin test was equivocal, Quantiferon test positive and 12 days later Mycobacterium tuberculosis was cultured from the pus. The patient was started on quadruple antituberculous therapy and his skin lumps have improved. The long term outcome of the osteomyelitis remains to be seen.