235 Knezevic et al. Tuberculosis of Cheek Skin Maced J Med Sci. 2009 Sep 15; 2(3):235-238. Macedonian Journal of Medical Sciences. 2009 Sep 15; 2(3):235-238. doi:10.3889/MJMS.1857-5773.2009.0065 Case Report Primary Tuberculosis of the Cheek skin: Difficulties in Diagnostic Procedure Predrag Knezevic, MD, PhD 1 , Bojana Knezevic, MD 2 , Mihael Skerlev, MD, PhD 3 , Vedran Uglesic, MD, PhD 4 , Vera Katalinic Jankovic, MD 5 1 Clinical Hospital Dubrava, Zagreb, Croatia; 2 Croatian Institute for Health Protection and Safety at Work, Zagreb, Croatia; 3 Clinical Hospital Center Zagreb, Zagreb, Croatia; 4 Clinical Hospital Dubrava, Zagreb, Croatia; 5 Croatian National Institute of Public Health, Zagreb, Croatia Key words: facial granulomas; chronic inflammation; skin tuberculosis; cutis; cheek tuberculo- sis. Correspondence: Predrag Knezevic Department of Maxillofacial and Oral Sur- gery, Clinical Hospital Dubrava, Av. G. Suska 6, 10000 Zagreb, Croatia Tel/Fax: 00385 1 2864 250 E-mail: pknezev@kbd.hr Received: 27-May-2009 Revised: 02-Sep-2009 Accepted: 02-Sep-2009 Online first: 07-Sep-2009 Abstract Background. Tuberculosis of the skin is rare disease in Europe. Diagnostic procedure is long and difficult. Aim. Aim of our manuscript is to point out that in differential diagnosis of chronic skin diseases, it is necessary to take tuberculosis into consideration as well. We represented rare case of cutaneous tuberculosis that required surgical procedure. Case report. A 46-year-old female, psychiatric patient, was referred to our clinic on surgical treatment of buccal abscess on the cheek. We extracted the teeth that were considered to be cause of inflammation, and the anthibiotic therapy was prescribed. Patient was seen after nearly two months. At the place of previous skin incision there was a visible fissure with surrounding erythematic and desquamation, and the fistula on the buccal mucous membrane. The findings of probatory biopsy showed elements of granulomatous inflammation. The first findings for Mycobacterium tuberculosis were negative. However, after five weeks the cultivation test was positive. The focus of infection was not found anywhere else. Conclusion. Despite of successful prevention programs over the world, tuberculosis is still public health problem in Balkan region. Cutanous tuberculosis, although very rare, is also present in this region. Early diagnose and patient’s compliance is very important for further treatment. Introduction The World Health Organization (WHO) has declared tuberculosis a global emergency in 1993 (1). Despite prevention programs, some authors found that tuberculosis in 2005 is still progressing endemically in developing countries. Incidence of tuberculosis is the highest in Africa and Asia (100- 250/100000 people) (2). In the high developed coun- tries incidence is under 20/10000 people, in East Europe incidence of tuberculosis are still increasing 4. 3% per year with incidence of 100/100000 people. According to WHO analyses of tuberculosis, Croatia was assorted in the part of Balkan region. In Balkan region rate of illnesses is decreasing 0.5% per year (3). In 1998 year Croatian Ministry of Health adopted a regulation “Instruction for control and prevention of tuberculosis”. In Croatia incidence decreased from 36/100000 people in 1996 year to 22/100000 in 2008 year (4). Cutaneous tuberculosis is rare in Europe, and more often in Africa and Asia and developing countries (3). Aim of our manuscript is to point out that in differential diagnosis of some chronic diseases, it is necessary to take tuberculosis into consideration as well. We represented women with rare case of cuta- neous tuberculosis that required surgical procedure. OPENｲACCESS