1. Chronic infection

2. ชื่อ นางชอ้อน เฉยดิษฐ์ อาจารย์เจ้าของไข้ ภูมิลำเนา จ. สิงห์บุรี เบอร์โทรศัพท์ 0811461894 Dx : chronic infection

3. CC : ผื่นที่แขนขา 2 ปี PE : no lymphadenopathy Skin : Bilateral, multiple indurated plaque at extremities

10. Bx : 17/2/58 Histopathology Irregular acanthosis of epidermis There is a mixed inflammatory cell infiltrate in the dermis to subcutaneous fat with fibrosis The inflammatory cell consist of lymphocytes, eosinophils, neutrophils, plasma cells and histiocytes No distinct granulomatous formation is identified No microorganism is seen The feature are suggest for chronic infection. Tissue culture is recommended.

11. Histo Dx : Chronic infection, mostly consider KOH at Lt leg : no fungus AFB at calf : negative Modified AFB at calf : negative Aerobic culture : no bacteria growth Culture for fungus : no fungal growth Culture for mycobacterium : No mycobacterium spp. growth PCR for MTB and NTM : negative

12. CBC : WBC 16,000 ( N 79% L 13%) Hb 9.4 HCt 29.8 Plt. 559,000 HBsAg : negative Loss F/U

13. Final diagnosis : Chronic infection