Lupus vulgaris and disseminated BCG.

A 3-year-old boy was found to have a non-tender, bony swelling at the base of his right thumb after presenting to A&E with an unrelated injury. The swelling had been present for 6 months and was increasing in size. An X-ray showed an enlarged right first metacarpal containing lytic and sclerotic areas suggestive of chronic osteomyelitis (figure 1A). A raised red/purple plaque was also noted on the lateral aspect of the left upper arm (figure …