Figure 1 Multiple skin pigmentation. A: Hyperpigmentation on the skin of face, mouth, tongue and mucous membranes of the lips; B-D: Hyperpigmentation on nails, hands and feet.

Figure 2 Histopathological analysis of the resected specimen. A and B: Haematoxylin and eosin staining (× 40). Pathology of cutaneous tuberculosis; C: Skin ulcers on the back.

Figure 3 Computed tomography scan of pulmonary tuberculosis before treatment. A and B: Upper field infection of both lungs; C: Computed tomography chest lung window coronal view shows bilateral lung infection.

Figure 4 Adrenal computed tomography scan of adrenal enlargement and calcification (orange arrow). A: Right adrenal gland enlargement and calcification at the orange arrow; B: Abdominal computed tomography coronal view shows enlargement and calcification of the right adrenal gland at the orange arrow.

Figure 5 Time line table of the patient. PAT: Prednisone.

Figure 6 Chest computed tomography scans before and after treatment. A and B: Before anti tuberculosis treatment; C and D: After 1 mo of treatment, chest computed tomography showed improvement in inflammation.

Figure 7 After 6 mo of treatment, the pigmentation was partially reversed. A: Hyperpigmentation on the skin of face, mouth, tongue and mucous membranes of the lips; B-D: Hyperpigmentation on nails, hands and feet.