Tuberculose cutanée de l'enfant au Maroc : étude de 30 cas

Cutaneous tuberculosis in children from the northeastern region of Morocco

INTRODUCTION

In Morocco, tuberculosis is an endemic disease. The aim of this study was to trace the epidemiological, paraclinical, therapeutic, and progressive characteristics of cutaneous tuberculosis (CT) in children.

MATERIALS AND METHOD

This multicenter retrospective and prospective study concerned all pediatric patients followed for CT in our region. The diagnosis was based on comparing clinical, immunological, bacteriological, and histological data.

RESULTS

We found 147 cases of CT, of which 16 cases (10%) were children. The average age was 10.5 years, with extremes ranging from 15 months to 16 years. The sex ratio was 0.75. Deterioration in general condition and weight loss were noted in three cases, and none of the patients was immunocompromised. The clinical forms were essentially scrofuloderma tuberculosis in nine cases (57%), gummas in five cases (35%), a single case each of verrucous tuberculosis and lupus vulgaris. The histological study of the lesions confirmed the diagnosis for all cases by showing a tuberculous granuloma. Multifocal forms were found in one case. Antibacillary treatment was recommended for 6 months in all patients except in the child with a multifocal form whose treatment was prolonged to 9 months. The progression was favorable with total healing in all cases except in a single case that retained sequelae such as bone deformities and scars in most cases.

DISCUSSION

Cutaneous tuberculosis in children is dominated by scrofuloderma and gummy lesions in our region. Despite deterioration in the general condition and weight loss in three cases, none of these children was immunocompromised. Therapeutic management was then carried out based on several clinical and paraclinical arguments and the histological study. Even if the compulsory BCG vaccine in Morocco prevents serious forms, early diagnosis remains the only way to reduce the risk of complications.

CONCLUSION

Cutaneous tuberculosis concerns our pediatric population, multibacillary forms of cutaneous localization is the most frequent one, although the BCG vaccine in Morocco is compulsory.

Sporotrichoid‐like tuberculosis in a child: Unusual clinico‐dermoscopic aspect

Tuberculosis‐ child ‐ Sporotrichoid ‐ clinical image ‐ dermoscopic image‐ correlation.

[Scrofuloderma: a misleading lesion]

We describe a case of scrofuloderma in an 8-year-old boy with a cutaneous tuberculosis lesion.

CASE REPORT

The child had spent holidays in Morocco. He presented a cutaneous lesion of the thigh which turned into an abscess with suppuration, in spite of surgical drainage. The lymph node analysis showed Koch bacilli and granuloma, leading to the diagnosis of scrofuloderma. Further exams found no other lesion. The course was favorable under treatment.

COMMENTS

With lupus vulgaris, scrofuloderma is the most common cutaneous tuberculosis lesion in children, particularly in developing countries. It is often associated with other organ lesions, such as bone or lung, and these must be sought. Scrofulodermas are unusual in Western countries, leading to misdiagnosis. Fortunately, adapted treatment most often results in recovery.