Scrofuloderma (tuberculosis colliquativa cutis).

A 16-year-old girl presented with long-standing purulent sinuses to the skin overlying the lacrimal ducts, which had evolved into ulcers and resulted in hypertrophic scarring. The ulcers were serpiginous, with an uneven soft floor, and undermined edges. Histological examination revealed non-caseating tuberculoid granulomas in the dermis. Cultures for Mycobacterium tuberculosis were positive. Chest X-ray did not show pulmonary involvement. Antituberculous therapy with isoniazid 300 mg/day and rifampicin 600 mg/day achieved a great improvement within 5 weeks of being started. A further improvement was seen at 4 months and complete resolution had occurred by 9 months. To the best of our knowledge, there are no other documented cases of scrofuloderma over the lacrimal system. The delay in the diagnosis emphasizes the importance of maintaining a high level of awareness.