Implantation cutaneous tuberculosis after ultrasound-guided fine needle aspiration cytology

A 45-year-old female presented with recurrent biliary pain, fever, anorexia and weight loss of 3 months duration. She was on highly active antiretroviral therapy for underlying human immunodeficiency virus infection for the past 5 months. Clinical examination revealed a 3-cm firm hepatomegaly. Investigations suggested mild anaemia, elevated erythrocyte sedimentation rate, deranged liver function tests, Mantoux test of 25 mm and CD4 count of 417 cells μl(−1). Ultrasonography revealed mild central intrahepatic biliary radical dilatation with a dilated common bile duct and multiple periportal and peripancreatic lymph nodes. Ultrasound-guided fine needle aspiration cytology (FNAC) from the periportal lymph node was performed twice. Both were reported as only bloody aspirate. The patient developed an erythematous tender skin nodule at the site of insertion of the FNAC needle 15 days after the second FNAC procedure. An excision biopsy of the nodule showed ill-formed epithelioid cell granulomas with acid-fast bacilli, indicating tuberculosis. The patient was started on antitubercular therapy with complete response.