Primary Mycobacterium tuberculosis infection over insulin injection site

Description

A 36-year-old man had been diagnosed with type 2 diabetes and put on twice daily premixed insulin for severe hyperglycaemia and osmotic symptoms about 3 months prior to his presentation to us. He was injecting himself with U-40 insulin syringe subcutaneously over anterior abdomen with proper technique and regular rotation of the injection sites. After about 2 months after starting insulin he had noticed multiple firm nodules appearing over the injection sites. The nodules were painless, became fluctuant over the course of time and used to burst spontaneously with discharge of pus. He had been put on several courses of oral antibiotics over the previous 2 months without any symptomatic relief. Some of the swellings required incision and drainage of the underlying pus. Gram stain and both aerobic and anaerobic culture of the drained pus were negative on multiple occasions.

A thorough systemic examination did not reveal any abnormality. Complete...

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