Atypical mycobacterial infection-a diagnostic challenge

We report an inexplicable case of recurrent multiple discharging sinuses, on labia majora and mons pubis in a 28 year old female patient with history of pulmonary Kochs. The discharge was related to the menstrual cycle. The pus collected from the lesion showed plenty of acid fast bacilli on microscopy but enigmatically culture showed no growth of Mycobacteria even after several tries. After excluding the probable differential diagnosis, we came to the conclusion that probably we are dealing with a case of Mycobacterium ulcerans but unfortunately neither could we cultivate the fastidious organism to speciate it nor could we perform the molecular diagnosis. The unusual site of Mycobacteria Other Than Tuberculosis (? M.ulcerans) infection prompted us to report the case.