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Soedjana H, Riestiano BE, Hasibuan LY, Harianti S. Management of cutaneous tuberculosis in hand - Rare and disabling: A case report. Int J Surg Case Rep 2024; 118:109631. [PMID: 38608519 PMCID: PMC11017280 DOI: 10.1016/j.ijscr.2024.109631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Cutaneous Tuberculosis (CTB), elicited by the Mycobacterium tuberculosis complex, manifests dermatologically. The scarcity of bacilli within CTB lesions renders their detection challenging. This study presents a case of CTB, underscoring its rarity and the potential for severe complications that can deteriorate patient quality of life. It aims to highlight the importance of CTB identification in dermatological diagnoses due to its capacity to cause considerable morbidity and affect patients' psychosocial health. CASE PRESENTATION An 18-year-old patient presented with a painful, well-defined reddish plaque on the right palm, originating five years prior, accompanied by contractures of the middle finger. The tender lesion, characterized by an irregular surface, exhibited purulent discharge upon light touch through fissures along its periphery. Management involved necrotomy, debridement, and tissue biopsy for diagnostic and reconstructive purposes. CLINICAL DISCUSSION CTB exhibits a wide range of clinical presentations, often resembling other dermatological infections, which complicates its diagnosis. Accurate diagnosis necessitates an integrated approach involving clinical assessment, the tuberculin skin test, histopathological analysis, and bacteriological investigations. The therapeutic regimen includes multidrug anti-tuberculosis treatment, with surgical intervention reserved for specific cases. CONCLUSION Long-term complications of untreated CTB encompass significant contractures, scarring, and the onset of carcinomas and sarcomas. Prompt diagnosis facilitates timely and effective treatment, averting these sequelae and yielding high patient satisfaction.
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Affiliation(s)
- Hardisiswo Soedjana
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
| | - Betha Egih Riestiano
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Lisa Y Hasibuan
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Selvy Harianti
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Yadav S. Non-traumatic Diaphragmatic Eventration With Extrapulmonary Tuberculosis Presenting As Pleural Effusion in an Indian Male: The First Report of Its Type. Cureus 2024; 16:e58163. [PMID: 38741827 PMCID: PMC11089338 DOI: 10.7759/cureus.58163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Tuberculosis is rampant in endemic countries. Extrapulmonary tuberculosis, like pleural effusion, is infrequently reported in outpatient departments. However, diaphragmatic eventration is rare and is not reported in active tuberculosis. Herein, the first-of-its-type case of a diaphragmatic eventration with tuberculous right pleural effusion in an Indian male is presented. The diagnosis was challenging and achieved through radiometric investigations and diagnostic pleural tapping. He was put on an anti-tuberculous treatment based on his weight.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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3
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Poonia K, Thami GP, Dogar K, Jain S. Clinico-Laboratory Profile of Tuberculides: An Experience at a Tertiary Care Centre from Chandigarh, India. Indian J Dermatol 2024; 69:201. [PMID: 38841219 PMCID: PMC11149802 DOI: 10.4103/ijd.ijd_1191_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background Tuberculides are characterised by delayed-type of immunologic reactions to Mycobacterium tuberculosis or its products in immuno-competent individuals. We herein describe clinico-epidemiological features and response to treatment in patients with tuberculides from a tertiary care centre from North India. Methods This was a retrospective analysis of the clinical records of all the cutaneous tuberculosis (TB) patients (year 2000-2019) enrolled in the TB clinic. The patient records fulfilling the diagnostic criteria of tuberculides were considered for analysis. Results A total of 225 patients attended the tuberculosis clinic; out of this, 34 were diagnosed as tuberculides. Out of these 34 cases, 21 were identified as LS, 2 erythema induratum of Bazin, 1 papulonecrotic tuberculide, and 10 erythema nodosum. History of contact to open cases of TB was present in 15/34 (44.1%) patients. History of BCG vaccination was found in 15/34 (44.1%) patients. The focus of underlying TB could be identified in 20/34 (58.8%) patients. Skin biopsy was performed in all patients. In all patients, the diagnosis was confirmed by clinico-pathological correlation, positive TST, and the underlying focus of TB. All patients received 6 months regimen of anti-tubercular therapy with first-line drugs. Conclusion In this study, we demonstrated various forms of tuberculides; lichen scrofulosorum was the most common form. We also included erythema nodosum cases also, which responded well to ATT. Observation from our study showed that tuberculides are important cutaneous markers for underlying tuberculosis infection, which helps in early detection of occult tuberculosis and timely management.
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Affiliation(s)
- Kavita Poonia
- From the Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, Punjab, India
- Department of Dermatology, Venereology and Leprology, All Indian Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gurvinder Pal Thami
- From the Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Kanika Dogar
- From the Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Surbhi Jain
- From the Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, Punjab, India
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Ntavari N, Syrmou V, Tourlakopoulos K, Malli F, Gerogianni I, Roussaki AV, Zafiriou E, Ioannou M, Tziastoudi E, Gourgoulianis KI, Pantazopoulos I. Multifocal Tuberculosis Verrucosa Cutis: Case Report and Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1758. [PMID: 37893476 PMCID: PMC10608037 DOI: 10.3390/medicina59101758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Cutaneous tuberculosis (TB) is still a major public health problem worldwide. Tuberculosis verrucosa cutis (TBVC) is a cutaneous form of exogenous TB caused by exogenous reinfection in previously sensitized individuals. TBVC typically presents as a unifocal condition. Multifocal cutaneous lesions without any other tubercular foci are extremely rare in exogenous TB and few cases are reported in the literature. We describe the first case of multifocal TBVC in an 81-year-old Greek man. In total, 14 cases of multifocal TBVC have been reported in the literature (8 males and 6 females), with mean age 47.64 years (SD = 20.75) and mean time to diagnosis of 9.69 years (SD = 15.31). Most cases (11/12) responded rapidly to treatment, implying the accuracy of diagnosis, while no one was reported to be immunocompromised. Finally, in 10 cases (71.4%), history of skin microtrauma was reported (related either to daily life habits or to professional praxis), confirming it as the main risk factor. The tuberculin skin test was positive in 10 cases and tissue culture for mycobacteria was negative in all cases. TBVC can present with multiple lesions, even in countries where TB prevalence is not high, especially in patients with history of skin abrasions. Prompt specialist assessment can expedite the establishment of diagnosis.
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Affiliation(s)
- Niki Ntavari
- Department of Dermatology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Vasiliki Syrmou
- Department of Rheumatology and Clinical Immunology, University of Thessaly, 41500 Larissa, Greece
| | | | - Foteini Malli
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
- Respiratory Disorders Lab, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece
| | - Irini Gerogianni
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | | | - Efterpi Zafiriou
- Department of Dermatology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Maria Ioannou
- Department of Pathology, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
| | - Eirini Tziastoudi
- Department of Pathology, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
| | | | - Ioannis Pantazopoulos
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
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Prasanna S, Mithari H, Kharkar V. A cross sectional descriptive study of dermoscopic features of clinical variants of cutaneous tuberculosis. Indian J Tuberc 2023; 70:501-507. [PMID: 37968058 DOI: 10.1016/j.ijtb.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 11/17/2023]
Abstract
Tuberculosis continues to be a major public health concern worldwide with almost 20-40% of the world's population being affected yearly. Cutaneous Tuberculosis (TB) is a rare and underdiagnosed entity that manifests in about 1-1.5% of extrapulmonary tuberculosis cases worldwide. Dermoscopy is a non-invasive tool which will be a useful aid to histopathology in the confirmation of the diagnosis alongside culture, and molecular techniques. This is a cross-sectional descriptive study that was conducted at a tertiary care center in Mumbai, India. A total of 31 patients were enrolled in this study; 14 males and 17 females. The mean duration of disease was 4.3 months and the average age was 31 years. There were 10 cases of lupus vulgaris, 7 scrofuloderma, 5 papulonecrotic tuberculid (PNT), 3 tuberculosis verrucosa cutis (TBVC), and 2 cases each of erythema induratum of Bazin, lichen scrofulosorum and resolved lupus vulgaris. All the lesions demonstrated orange yellow background suggestive of dermal granuloma. Other key dermoscopic features noted include yellowish-white scales, patulous follicles, white structureless areas, milia-like cysts, white streaks, pigment globules, hairpin and linear vessels. Newer findings such as the crown of vessels and perifollicular pallor in lichen scrofulosorum, and radiating white streaks in PNT were also noted. Dermoscopy of infective granulomas such as cutaneous tuberculosis is a less explored field of dermatology. Newer dermoscopic features of each clinical variant of cutaneous TB have been described.
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Affiliation(s)
- Swati Prasanna
- Seth G.S. Medical College & K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai, 400012, India.
| | - Hershada Mithari
- Seth G.S. Medical College & K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai, 400012, India
| | - Vidya Kharkar
- Seth G.S. Medical College & K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai, 400012, India
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Kumar M, Virmani T, Kumar G, Deshmukh R, Sharma A, Duarte S, Brandão P, Fonte P. Nanocarriers in Tuberculosis Treatment: Challenges and Delivery Strategies. Pharmaceuticals (Basel) 2023; 16:1360. [PMID: 37895831 PMCID: PMC10609727 DOI: 10.3390/ph16101360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
The World Health Organization identifies tuberculosis (TB), caused by Mycobacterium tuberculosis, as a leading infectious killer. Although conventional treatments for TB exist, they come with challenges such as a heavy pill regimen, prolonged treatment duration, and a strict schedule, leading to multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. The rise of MDR strains endangers future TB control. Despite these concerns, the hunt for an efficient treatment continues. One breakthrough has been the use of nanotechnology in medicines, presenting a novel approach for TB treatment. Nanocarriers, such as lipid nanoparticles, nanosuspensions, liposomes, and polymeric micelles, facilitate targeted delivery of anti-TB drugs. The benefits of nanocarriers include reduced drug doses, fewer side effects, improved drug solubility, better bioavailability, and improved patient compliance, speeding up recovery. Additionally, nanocarriers can be made even more targeted by linking them with ligands such as mannose or hyaluronic acid. This review explores these innovative TB treatments, including studies on nanocarriers containing anti-TB drugs and related patents.
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Affiliation(s)
- Mahesh Kumar
- School of Pharmaceutical Sciences, Modern Vidya Niketan University, Palwal 121105, India; (M.K.); (G.K.); (A.S.)
| | - Tarun Virmani
- School of Pharmaceutical Sciences, Modern Vidya Niketan University, Palwal 121105, India; (M.K.); (G.K.); (A.S.)
| | - Girish Kumar
- School of Pharmaceutical Sciences, Modern Vidya Niketan University, Palwal 121105, India; (M.K.); (G.K.); (A.S.)
| | - Rohitas Deshmukh
- Institute of Pharmaceutical Research, GLA University, Mathura 281406, India;
| | - Ashwani Sharma
- School of Pharmaceutical Sciences, Modern Vidya Niketan University, Palwal 121105, India; (M.K.); (G.K.); (A.S.)
| | - Sofia Duarte
- iBB—Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, University of Lisboa, 1049-001 Lisbon, Portugal; (S.D.); (P.B.)
- Associate Laboratory i4HB—Institute for Health and Bio-Economy, Instituto Superior Técnico, University of Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
| | - Pedro Brandão
- iBB—Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, University of Lisboa, 1049-001 Lisbon, Portugal; (S.D.); (P.B.)
- Associate Laboratory i4HB—Institute for Health and Bio-Economy, Instituto Superior Técnico, University of Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
- CQC-IMS, Department of Chemistry, University of Coimbra, Rua Larga, 3004-535 Coimbra, Portugal
| | - Pedro Fonte
- iBB—Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, University of Lisboa, 1049-001 Lisbon, Portugal; (S.D.); (P.B.)
- Associate Laboratory i4HB—Institute for Health and Bio-Economy, Instituto Superior Técnico, University of Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
- Center for Marine Sciences (CCMar), University of Algarve, Gambelas Campus, 8005-139 Faro, Portugal
- Department of Chemistry and Pharmacy, Faculty of Sciences and Technology, University of Algarve, Gambelas Campus, 8005-139 Faro, Portugal
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van Staden D, Haynes RK, Viljoen JM. The Development of Dermal Self-Double-Emulsifying Drug Delivery Systems: Preformulation Studies as the Keys to Success. Pharmaceuticals (Basel) 2023; 16:1348. [PMID: 37895819 PMCID: PMC10610238 DOI: 10.3390/ph16101348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Self-emulsifying drug delivery systems (SEDDSs) are lipid-based systems that are superior to other lipid-based oral drug delivery systems in terms of providing drug protection against the gastrointestinal (GI) environment, inhibition of drug efflux as mediated by P-glycoprotein, enhanced lymphatic drug uptake, improved control over plasma concentration profiles of drugs, enhanced stability, and drug loading efficiency. Interest in dermal spontaneous emulsions has increased, given that systems have been reported to deliver drugs across mucus membranes, as well as the outermost layer of the skin into the underlying layers. The background and development of a double spontaneous emulsion incorporating four anti-tubercular drugs, clofazimine (CFZ), isoniazid (INH), pyrazinamide (PZY), and rifampicin (RIF), are described here. Our methods involved examination of oil miscibility, the construction of pseudoternary phase diagrams, the determination of self-emulsification performance and the emulsion stability index of primary emulsions (PEs), solubility, and isothermal micro calorimetry compatibility and examination of emulsions via microscopy. Overall, the potential of self-double-emulsifying drug delivery systems (SDEDDSs) as a dermal drug delivery vehicle is now demonstrated. The key to success here is the conduct of preformulation studies to enable the development of dermal SDEDDSs. To our knowledge, this work represents the first successful example of the production of SDEDDSs capable of incorporating four individual drugs.
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Affiliation(s)
- Daniélle van Staden
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); (R.K.H.)
| | - Richard K. Haynes
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); (R.K.H.)
- Rural Health Research Institute, Charles Sturt University, 346 Leeds Parade, Orange, NSW 2800, Australia
| | - Joe M. Viljoen
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); (R.K.H.)
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Aso K. Scrofuloderma and Miliary Tuberculosis in a Patient Taking Adalimumab. J Gen Intern Med 2023; 38:2832-2833. [PMID: 36932267 PMCID: PMC10506993 DOI: 10.1007/s11606-023-08162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Kuniyuki Aso
- Department of Rheumatology, NTT Sapporo Medical Center, Sapporo, Japan.
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9
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Maloney ME, Cohen B. Cutaneous tuberculosis in the pediatric population: A review. JAAD Int 2023; 12:105-111. [PMID: 37404246 PMCID: PMC10315778 DOI: 10.1016/j.jdin.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 07/06/2023] Open
Abstract
Importance Tuberculosis (TB) is a significant health concern, affecting over 1.5 million people annually worldwide, with the incidence increasing in the United States from 2020 to 2021. The pediatric population is particularly vulnerable to TB. Extrapulmonary manifestations of TB include cutaneous tuberculosis (CTB). Observations There are 8 forms of CTB. Lupus vulgaris (LV) is the second most common form of pediatric CTB which presents nontender plaques or nodules with ulceration that progress to well-defined, scaly plaques. Tuberculous chancre results from exogenous inoculation and lesions contain large amounts of acid-fast bacilli (AFB). Clinically, tuberculous chancre presents as erythematous papules which form firm nontender ulcers. Tuberculosis verrucose cutis (TVC) presents as small papules surrounded by inflammation that develops into a wart-like lesion. Periorificial lesions are rare and present as painful ulcers in the oral or perineal regions. Scrofuloderma is the most common form of pediatric CTB and presents as nodules that ulcerate, forming purulent sinus tracts. Tuberculosis miliaris cutis disseminate presents as widespread papules and crusted vesicles. Metastatic abscesses present as multiple nodules that may ulcerate or form draining sinus tracts. Lastly, tuberculid forms include lichen scrofulosorum (LS), which presents as lichenoid papules which may form plaques and scale, and papulonecrotic tuberculid, which presents as necrotic papules. All forms of cutaneous tuberculosis can be treated with the standard 6-month, four-drug anti-tuberculosis treatment (ATT). Some cases of CTB may require debriding and surgical management in addition to ATT. Conclusions and Relevance Determining the type of CTB can be challenging clinically. Histopathology is needed to make the diagnosis. Chest x-ray and a review of systems should be obtained for CTB patients to determine if there are other extrapulmonary manifestations of TB. All types are treated with 6 months of ATT.
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Affiliation(s)
| | - Bernard Cohen
- Department of Dermatology and Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Nguyen KH, Alcantara CA, Glassman I, May N, Mundra A, Mukundan A, Urness B, Yoon S, Sakaki R, Dayal S, Chowdhury T, Harshavardhan S, Ramanathan V, Venketaraman V. Cutaneous Manifestations of Mycobacterium tuberculosis: A Literature Review. Pathogens 2023; 12:920. [PMID: 37513768 PMCID: PMC10385667 DOI: 10.3390/pathogens12070920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Tuberculosis is an ancient disease that humanity struggled with for centuries and continues to struggle with. The bacteria Mycobacterium tuberculosis often infects the lungs through respiratory transmission and manifests itself through various symptoms, including cutaneous infections. Cutaneous tuberculosis (CTB) comprises about 1% to 1.5% of all extrapulmonary manifestations and is often accompanied by polymorphous lesions, including papules, nodules, plaques, ulcers, gummas, and verrucous lesions. CTB is most commonly observed in low-income, HIV, and immunosuppressed populations, similar to intrapulmonary manifestations. The main pathogen for CTB is M. tuberculosis but less commonly with M. bovis and BCG vaccine, and the modes of transmission are largely classified into exogenous and endogenous CTB. Current treatment options for CTB include oral therapy of antibiotic medications such as rifampicin, streptomycin, ethambutol, isoniazid, and pyrazinamide, which is occasionally combined with surgical intervention.
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Affiliation(s)
- Kevin H Nguyen
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Cheldon Ann Alcantara
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Ira Glassman
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Nicole May
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Akaash Mundra
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Abinanda Mukundan
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Bianca Urness
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Sonyeol Yoon
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Roajhaan Sakaki
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Surbi Dayal
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Tanzila Chowdhury
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Shakila Harshavardhan
- Department of Molecular Microbiology, Madurai Kamaraj University, Tamil Nadu 625021, India
| | - Vadakupattu Ramanathan
- Department of Pathology, National Institute for Research in Tuberculosis, Chennai 600031, India
| | - Vishwanath Venketaraman
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
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Lino R, Amorim S, Silva C, Neves N, Araújo P, Pinto R, Pinheiro-Torres J, Pinho P, Macedo F, Santos L. Cutaneous Tuberculosis in Heart Transplant. Transplant Proc 2023; 55:1444-1448. [PMID: 37142508 DOI: 10.1016/j.transproceed.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023]
Abstract
Tuberculosis is a disease with a significant global burden in terms of morbidity and mortality. It usually presents as a pulmonary disease but can occasionally have extrapulmonary presentations. Immunosuppressed people are at an increased risk of tuberculosis and more frequently have atypical manifestations of the disease. Cutaneous involvement is estimated to occur in only 2% of extrapulmonary presentations. We report a case of a heart transplant recipient with disseminated tuberculosis who initially presented with cutaneous manifestations in the form of multiple abscesses that were mistaken for a community-acquired bacterial infection. The diagnosis was made after positive nucleic acid amplification testing and cultures for Mycobacterium tuberculosis from the drainage of the abscesses. After initiating antituberculous treatment, the patient had 2 instances of immune reconstitution inflammatory syndrome. A combination of diminished immunosuppression due to discontinuation of mycophenolate mofetil in the setting of acute infection, rifampin drug interactions with cyclosporine, and the beginning of treatment of tuberculosis all contributed to this paradoxical worsening. The patient responded favorably to increased glucocorticoid therapy and showed no signs of treatment failure after 6 months of antituberculous therapy.
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Affiliation(s)
- Rita Lino
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Sandra Amorim
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudio Silva
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nélia Neves
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Araújo
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Pinheiro-Torres
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Pinho
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipe Macedo
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; ESCMID Study Group for Infections in Compromised Hosts, European Society of Clinical Microbiology and Infectious Diseases
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van Heerden JK, Broadhurst AGB, de Jager RS, du Plessis W, Ebrahim N, Mnguni AT, Schietekat D, Meintjes G. Cutaneous tuberculosis: An infrequent manifestation of a common pathogen in South Africa. S Afr J Infect Dis 2023; 38:526. [PMID: 37435117 PMCID: PMC10331026 DOI: 10.4102/sajid.v38i1.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Cutaneous tuberculosis is an infrequent form of extra-pulmonary tuberculosis, even in high-prevalence settings. We present the case of a patient living with advanced HIV who developed extensive cutaneous tuberculosis. The polymorphic skin lesions were the most striking clinical manifestation of underlying disseminated tuberculosis. Contribution This case report highlights an unusual presentation of tuberculosis. Cutaneous tuberculosis has a wide spectrum of clinical presentations and may be under-recognised by clinicians. We recommend early biopsy for microbiological diagnosis.
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Affiliation(s)
- Jennifer K van Heerden
- Department of Internal Medicine, Khayelitsha District Hospital, Western Cape Department of Health, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alistair G B Broadhurst
- Division of General Internal Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ruan S de Jager
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Wesley du Plessis
- Division of General Internal Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Nabilah Ebrahim
- Division of General Internal Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ayanda T Mnguni
- Department of Internal Medicine, Khayelitsha District Hospital, Western Cape Department of Health, Cape Town, South Africa
| | - Denzil Schietekat
- Department of Internal Medicine, Khayelitsha District Hospital, Western Cape Department of Health, Cape Town, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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13
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Haque OI, Rizvi SA, Siddiqui Z. Disseminated tuberculosis involving the eye, skin, axillary lymph nodes and lungs in an immunocompetent host. BMJ Case Rep 2023; 16:e254392. [PMID: 37188489 PMCID: PMC10186401 DOI: 10.1136/bcr-2022-254392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
A female in her early 40s presented to the outpatient clinic for weight loss, fatigue, cough, followed by a gradual painful loss of vision in the right eye associated with redness over the past 3 months. Physical examination revealed bilateral axillary lymphadenopathy and non-healing skin ulcers on the left forearm and the left gluteal region. The patient had no light perception in the right eye and grade 4+ cells in the anterior chamber. A chest X-ray showed a cavitary lesion in the left upper lobe. Histopathological tests from the skin and lymph nodes revealed caseating granulomas, raising the suspicion of tuberculosis. A sputum nucleic acid amplification test was performed, which returned positive for Mycobacterium tuberculosis The patient was treated with antitubercular chemotherapy and showed encouraging signs of progress after the treatment.
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Affiliation(s)
| | - Syed Asghar Rizvi
- Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
| | - Ziya Siddiqui
- Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
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14
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Cutaneous Deep Ulcerations as Initial Presentations of Granulomatosis with Polyangiitis: Two Case Reports and Differential Diagnosis. Medicina (B Aires) 2023; 59:medicina59030563. [PMID: 36984564 PMCID: PMC10057340 DOI: 10.3390/medicina59030563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
Background: Granulomatosis with polyangiitis (GPA) is an antineutrophil-cytoplasmic-antibody (ANCA)-associated small-vessel vasculitis characterized by necrotizing granulomatous inflammation. Symptoms of skin involvement can appear in 30–50% of patients with GPA, and may present as the initial presentation. Case Presentation: We describe two patients who presented with multiple deep, large, nonhealing skin ulcers postoperatively with purulent drainage and fever. Both patients were diagnosed with GPA after an extensive evaluation, including histopathology. Infectious, connective tissue disease and malignant etiologies were excluded. Their cANCA and PR3-ANCA levels were positive. Patient 2 was diagnosed early and recovered well after treatment with corticosteroids and rituximab; however, Patient 1 had a poor prognosis due to a long disease course. Conclusions: Diseases with multiple deep, large skin ulcers and fever can be infectious or noninfectious. Atypical manifestations may lead to missed diagnosis and misdiagnosis. GPA may initially present in a localized form before progressing to a generalized disease. The two cases we have highlighted will prompt clinicians to nevertheless call for a low threshold for diagnosis.
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15
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Cutaneous and Pulmonary Tuberculosis-Diagnostic and Therapeutic Difficulties in a Patient with Autoimmunity. Pathogens 2023; 12:pathogens12020331. [PMID: 36839603 PMCID: PMC9959720 DOI: 10.3390/pathogens12020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Cutaneous tuberculosis (CTB) is a very rare disease and accounts for only 1-2% of cases of extrapulmonary tuberculosis (EPTB). Due to the variety of its clinical manifestations, the uncharacteristic appearance of its lesions, resembling other dermatoses in the early stages, and the limited experience of clinicians due to the rarity of CTB, diagnosis is very difficult. Particularly noteworthy is the fact that most cases of EPTB, including skin tuberculosis (TB), can be a manifestation of systemic involvement. In this paper, we present a case of an immunocompromised patient who was diagnosed with CTB almost a year after the first dermatological lesions were located on the lower extremities. At the same time, due to respiratory symptoms, a diagnosis of pulmonary TB (PTB) was made, and radiological and microbiological confirmations were obtained.
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16
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Gong Y, Gu J. Facial scrofuloderma. J Cosmet Dermatol 2023; 22:1424-1425. [PMID: 36700383 DOI: 10.1111/jocd.15562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/15/2022] [Accepted: 11/29/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Yu Gong
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Jun Gu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
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17
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Zdziarski P, Paściak M, Chudzik A, Kozińska M, Augustynowicz-Kopeć E, Gamian A. Cutaneous tuberculosis-ambiguous transmission, bacterial diversity with biofilm formation in humoral abnormality: case report illustration. Front Public Health 2023; 11:1091373. [PMID: 37213612 PMCID: PMC10194659 DOI: 10.3389/fpubh.2023.1091373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/27/2023] [Indexed: 05/23/2023] Open
Abstract
Background Cutaneous tuberculosis (CTB) and its paucibacillary forms are rare and difficult to diagnose, especially in immunocompromised patients with significant comorbidity. The aim of the study was to introduce the modern concept of the microbiome and diagnostic chain into clinical practice (patient-centered care) with the presentation of an atypical form of cutaneous tuberculosis with necrotizing non-healing ulcers leading to polymicrobial infection. Methods The study material included samples from sputum, broncho-alveolar lavage and skin ulcer, taken from a patient developing cutaneous tuberculosis. The microbiological investigation was performed, and identification of the isolates was carried out using genotyping and the matrix-assisted laser desorption ionization-time of flight mass spectrometry. Results The immunocompromised patient with humoral abnormality (plasma cell dyscrasia) and severe paraproteinemia developed multiorgan tuberculosis. Although cutaneous manifestation preceded systemic and pulmonary symptoms (approximately half a year), the mycobacterial genotyping confirmed the same MTB strain existence in skin ulcers and the respiratory system. Therefore, the infectious chain: transmission, the portal of entry, and bacterial spreading in vivo, were unclear. Microbial diversity found in wound microbiota (among others Gordonia bronchialis, Corynebacterium tuberculostearicum, Staphylococcus haemolyticus, and Pseudomonas oryzihabitans) was associated with the spread of a skin lesion. The in vitro biofilm-forming capacity of strains isolated from the wound may represent the potential virulence of these strains. Thus, the role of polymicrobial biofilm may be crucial in ulcer formation and CTB manifestation. Conclusions Severe wound healing as a unique biofilm-forming niche should be tested for Mycobacterium (on species and strain levels) and coexisting microorganisms using a wide range of microbiological techniques. In immunodeficient patients with non-typical CTB presentation, the chain of transmission and MTB spread is still an open issue for further research.
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Affiliation(s)
- Przemysław Zdziarski
- Department of Clinical Immunology, Tuberculosis and Pulmonary Disease, Lower Silesian Oncology Center, Wroclaw, Poland
- *Correspondence: Przemysław Zdziarski
| | - Mariola Paściak
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Anna Chudzik
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Monika Kozińska
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Ewa Augustynowicz-Kopeć
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Andrzej Gamian
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
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18
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Caguana Vélez OA, Sánchez-Font A, Zuccarino F, Domínguez-Álvarez M. [Dactylitis and Cutaneous Abscess Presenting as Disseminated Tuberculosis]. OPEN RESPIRATORY ARCHIVES 2023; 5:100215. [PMID: 37497253 PMCID: PMC10369640 DOI: 10.1016/j.opresp.2022.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Affiliation(s)
| | - Albert Sánchez-Font
- Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, UPF, ISCIII, Barcelona, España
- Servei Pneumologia. IMIM, Hospital del Mar, Medical Research Institute, Barcelona, España
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Flavio Zuccarino
- Servei de Radiodiagnòstic, Hospital del Mar-Parc de Salut Mar, Barcelona, España
| | - Marisol Domínguez-Álvarez
- Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, UPF, ISCIII, Barcelona, España
- Servei Pneumologia. IMIM, Hospital del Mar, Medical Research Institute, Barcelona, España
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19
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Garon L, Hill A. A case of scrofuloderma of the axilla presenting as hidradenitis suppurativa: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221117706. [PMID: 36225223 PMCID: PMC9549081 DOI: 10.1177/2050313x221117706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Scrofuloderma is an uncommon cutaneous presentation of tuberculosis. It can be
difficult to diagnose, as it can mimic various skin conditions, including
hidradenitis suppurativa. We report a case of a 46-year-old female refugee
patient with a history of nodules and sinus tracts in the left axilla treated
for many years as hidradenitis suppurativa in her home country who was later
found to have scrofuloderma. The diagnosis was based on a positive
Mycobacterium tuberculosis polymerase chain reaction from
an ultrasound-guided aspiration. Further investigation excluded pulmonary
tuberculosis. In cases with an atypical presentation of hidradenitis
suppurativa, imaging, along with histological and microbiologic examination are
warranted to exclude scrofuloderma.
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Affiliation(s)
- Laurence Garon
- Laurence Garon, Division of Dermatology,
Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM),
Montréal, QC, Canada H2X 0C1.
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20
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Loza Canales SM, Bravo Puccio FG, Del Solar Chacaltana MA, Feria Saldaña KH, León AV, Tico Chayña JR. Multisystemic tuberculosis with skin involvement in a patient with compromised cellular immunity suggestive of primary immunodeficiency. JAAD Case Rep 2022; 30:79-82. [DOI: 10.1016/j.jdcr.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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21
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Yadav S. A Case of Cutaneous Tuberculosis Presenting As Lupus Vulgaris in an Immunocompetent Indian Child During the Pandemic of COVID-19. Cureus 2022; 14:e27996. [PMID: 36134095 PMCID: PMC9469781 DOI: 10.7759/cureus.27996] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/19/2022] Open
Abstract
Cutaneous tuberculosis is a rare finding in clinical settings. However, cases of this type of TB are commonly reported from the high burden countries. The diagnosis of cutaneous tuberculosis is difficult, especially due to the paucibacillary nature of this disease and its similarities with other cutaneous infections. Also, there is low sensitivity and specificity in almost all diagnostic tests. Therefore, it requires a detailed history, with a rigorous clinical workup to establish the diagnosis. The diagnosis becomes even more challenging when the situation is grave due to an ongoing pandemic. During the current pandemic of COVID-19, there was lesser attention paid to other diseases. Most of the outpatient departments like dermatology were shut and human resources were utilized for COVID-19 care. The author herein presents a case of cutaneous tuberculosis presenting as lupus vulgaris in an Indian child diagnosed during the third wave of the pandemic of COVID-19.
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22
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van Staden D, Haynes RK, Viljoen JM. Adapting Clofazimine for Treatment of Cutaneous Tuberculosis by Using Self-Double-Emulsifying Drug Delivery Systems. Antibiotics (Basel) 2022; 11:antibiotics11060806. [PMID: 35740212 PMCID: PMC9219976 DOI: 10.3390/antibiotics11060806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 12/10/2022] Open
Abstract
Although chemotherapeutic treatment regimens are currently available, and considerable effort has been lavished on the development of new drugs for the treatment of tuberculosis (TB), the disease remains deeply intractable and widespread. This is due not only to the nature of the life cycle and extraordinarily disseminated habitat of the causative pathogen, principally Mycobacterium tuberculosis (Mtb), in humans and the multi-drug resistance of Mtb to current drugs, but especially also to the difficulty of enabling universal treatment of individuals, immunocompromised or otherwise, in widely differing socio-economic environments. For the purpose of globally eliminating TB by 2035, the World Health Organization (WHO) introduced the "End-TB" initiative by employing interventions focusing on high impact, integrated and patient-centered approaches, such as individualized therapy. However, the extraordinary shortfall in stipulated aims, for example in actual treatment and in TB preventative treatments during the period 2018-2022, latterly and greatly exacerbated by the COVID-19 pandemic, means that even greater pressure is now placed on enhancing our scientific understanding of the disease, repurposing or repositioning old drugs and developing new drugs as well as evolving innovative treatment methods. In the specific context of multidrug resistant Mtb, it is furthermore noted that the incidence of extra-pulmonary TB (EPTB) has significantly increased. This review focusses on the potential of utilizing self-double-emulsifying drug delivery systems (SDEDDSs) as topical drug delivery systems for the dermal route of administration to aid in treatment of cutaneous TB (CTB) and other mycobacterial infections as a prelude to evaluating related systems for more effective treatment of CTB and other mycobacterial infections at large. As a starting point, we consider here the possibility of adapting the highly lipophilic riminophenazine clofazimine, with its potential for treatment of multi-drug resistant TB, for this purpose. Additionally, recently reported synergism achieved by adding clofazimine to first-line TB regimens signifies the need to consider clofazimine. Thus, the biological effects and pharmacology of clofazimine are reviewed. The potential of plant-based oils acting as emulsifiers, skin penetration enhancers as well as these materials behaving as anti-microbial components for transporting the incorporated drug are also discussed.
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23
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Varpuluoma O, Sinikumpu SP, Jackson P, Tasanen K, Huilaja L. Ulcerative Tuberculosis in a Patient Treated with Adalimumab. Acta Derm Venereol 2022; 102:adv00700. [DOI: 10.2340/actadv.v102.1616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short Communication)
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24
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Huang Z, Qian J, Jin Q, Liu F, Zhang G, Gu H, Fu L, Wang Y, Zhang X, Yu Y, Sun J. Expression and Analyses of CXCL9/10/11 and CXCR3 in Ulcerative Cutaneous Tuberculosis. J Interferon Cytokine Res 2022; 42:180-190. [PMID: 35438529 DOI: 10.1089/jir.2021.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We explored the biological functions, signaling pathways, potential inflammation, and immune biomarkers involved in ulcerative cutaneous tuberculosis (UCT). Mycobacterium tuberculosis-infected tissues from UCT patients and patients with noncutaneous tuberculous ulcers (NCTUs) were studied using transcriptomic analysis. Functional enrichment determined using the Gene Ontology database and enrichment of signaling pathways was ascertained using the Kyoto Encyclopedia of Genes and Genomes database. Protein-protein interaction (PPI) networks were analyzed to determine the hub genes. A total of 4,396 differentially expressed genes (DEGs) were identified. DEGs were enriched in CXCR3 chemokine receptor binding, chemokine activity, and cytokine-cytokine receptor interaction and other aspects. Analyses of PPI networks identified 15 hub genes. Expression of chemokine (C-X-C motif) ligand 9 (CXCL9)/10/11 messenger RNA (mRNA) and C-X-C motif chemokine receptor 3 (CXCR3) mRNA in the lesions of patients with UCT increased compared with that in NCTU cases. Expression of CXCL9 mRNA and CXCL10 mRNA in plasma also increased, which was consistent with other test results. We discovered a novel plasma CXC chemokine signature that could be used to differentiate UCT from NCTU. Our study (1) provides a reference for UCT diagnosis and selection of diagnostic markers and (2) lays the foundation for further elucidation of UCT pathogenesis.
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Affiliation(s)
- Zihui Huang
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Jiayan Qian
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Quanyong Jin
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Fang Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Jiangsu, China
| | - Guoying Zhang
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Hongwei Gu
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Liangjie Fu
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Yuling Wang
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - XiaoYang Zhang
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Yang Yu
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Jiayue Sun
- Nanjing Municipal Hospital of Traditional Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
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25
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Villagrasa-Boli P, Monte-Serrano J, Alcon-Flores F. Masa cervical supurativa en paciente con lesiones pulmonares. Semergen 2022; 48:e23-e24. [PMID: 35151556 DOI: 10.1016/j.semerg.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
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26
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Isoletta E, Ciolfi C, Bonometti A, Sachs M, Brazzelli V. An atypical presentation of tuberculous gumma heralding a diagnosis of lymph node tuberculosis: hindsight is 20/20. JAAD Case Rep 2022; 24:14-17. [PMID: 35542318 PMCID: PMC9079164 DOI: 10.1016/j.jdcr.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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27
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Disseminated tuberculosis with paradoxical reactions caused by a Mycobacterium tuberculosis strain belonging to the Indo-Oceanic lineage: An imported case in Japan. J Infect Chemother 2022; 28:965-970. [DOI: 10.1016/j.jiac.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/30/2021] [Accepted: 02/06/2022] [Indexed: 11/20/2022]
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28
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Wang ZZ, Jiang HQ, Wang HS. Disseminated Ulcerated Nodules: A Quiz. Acta Derm Venereol 2022; 102:adv00622. [PMID: 34904688 PMCID: PMC9609984 DOI: 10.2340/actadv.v101.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is not available (Quiz)
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Affiliation(s)
| | - Hai-Qin Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China.
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29
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Verma P, Suvirya S, Jha A, Shukla P, Singhai A. Atypical presentations of cutaneous tuberculosis: Series of 10 cases. Indian J Tuberc 2022; 69:113-119. [PMID: 35074143 DOI: 10.1016/j.ijtb.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/18/2020] [Accepted: 02/03/2021] [Indexed: 06/14/2023]
Abstract
Cutaneous tuberculosis classically presents as Lupus vulgaris, scrofuloderma, tuberculosis verrucose cutis and tubercular abscess. Hypersensitivity reaction to the bacilli leads to Lichen scrofulosorum and papulonecrotic tuberculids. At the same time, it can have myriad of clinical presentations, many of which are still undescribed. It is important to regularly update ourselves with these unusual manifestations so as to ensure early treatment and reduction of overall morbidity. In this case series tuberculosis manifesting as rapidly progressing diffuse facial granulomas, sporotrichoid tuberculosis, tuberculosis mimicking squamous cell carcinoma, scrofuloderma as tubercular ulcer, lupus vulgaris with nasal septal perforation, lupus vulgaris resembling furuncle, psoriasis, dermatitis and BT Hansen are described in immunocompetent individuals. These cases highlight the importance of recognition of atypical forms of cutaneous tuberculosis to minimize scarring and dissemination of bacilli.
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Affiliation(s)
- P Verma
- Department of Dermatology Venereology and Leprosy, King George's Medical University, Lucknow, UP, 226003, India.
| | - S Suvirya
- Department of Dermatology Venereology and Leprosy, King George's Medical University, Lucknow, UP, 226003, India
| | - A Jha
- Department of Dermatology, Adesh Medical College and Hospital, Ambala, India
| | - P Shukla
- Department of Dermatology Venereology and Leprosy, King George's Medical University, Lucknow, UP, 226003, India
| | - A Singhai
- Department of Pathology, King George's Medical University, Lucknow, UP, 226003, India
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30
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Brito ACD, Oliveira CMMD, Unger DAA, Bittencourt MDJS. Cutaneous tuberculosis: epidemiological, clinical, diagnostic and therapeutic update. An Bras Dermatol 2022; 97:129-144. [PMID: 34996655 PMCID: PMC9073256 DOI: 10.1016/j.abd.2021.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis is certainly one of the diseases considered to be ancient on planet Earth. The etiological agent of tuberculosis is Mycobacterium tuberculosis. This terrible bacterial infection still results in severe socioeconomic consequences to date, and its complete eradication represents a great challenge. It constitutes one of the most important public health problems in developing countries. According to the World Health Organization, this infection results in more than 4,000 deaths daily worldwide, with 10.4 million being affected annually and 1.5 million deaths from TB every year. With the emergence of the HIV/AIDS pandemic, the disease became the main cause of morbidity and mortality in patients infected with the human immunodeficiency virus. Cutaneous tuberculosis is a rare infection that represents 1% to 1.5% of extrapulmonary tuberculosis, whose etiological agents are Mycobacterium tuberculosis, Mycobacterium bovis, and the attenuated form of the bacillus Calmette-Guérin (BCG vaccine). Cutaneous tuberculosis can be exogenous; endogenous: caused by contiguity or autoinoculation and by hematogenous spread; induced by the Calmette-Guérin bacillus and manifest as a tuberculid. The diagnosis of the infection is carried out through the direct test, culture, histopathology, tuberculin skin test, polymerase chain reaction, interferon-gamma release assay, and genotyping. Drugs used comprise isoniazid, rifampicin, pyrazinamide and ethambutol.
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Kiing JW, Hasnan Najib SFBZ, Muniandy P. Lupus vulgaris on the arm mistaken for keloid. Australas J Dermatol 2021; 63:e103-e105. [DOI: 10.1111/ajd.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Jiu Wen Kiing
- Dermatology Department Sarawak General Hospital KuchingMalaysia
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Sabbadini C, Oberschmied J, Tauber M, Nobile C. A rare case of scrofuloderma along with lupus vulgaris. Dermatol Reports 2021; 13:8993. [PMID: 34880968 PMCID: PMC8611515 DOI: 10.4081/dr.2021.8993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Cutaneous forms of tuberculosis are rare, comprising about 1-1.5% of all cases, and show a wide range of clinical manifestations. Here we present a case of a patient with left cervical ulcerated lymphadenopathy associated with a violaceous plaque in the area of the manubrium of sternum. We performed a biopsy of the plaque for histopathology, a polymerase chain reaction (PCR) to test for mycobacteria and a smear of the ulcerated lymph node. Histopathology results showed a dermal infiltrate consisting of epithelioid granulomas without necrosis, PCR was negative, and the culture was positive for M. tuberculosis. We made the diagnosis of scrofuloderma associated with lupus vulgaris. The patient was treated with an anti-tuberculous therapy with clinical regression of the lesions. Our case emphasizes the importance of recognizing that tuberculosis can occur as a primary cutaneous pathology, with a challenging diagnosis that requires the correlation of clinical findings with diagnostic testing. Transient acantholytic dermatosis (TAD) is a relatively common entity that has been also noted to occur in patients with cancer. Herein, we describe a case of transient acantholytic dermatosis occurring in a patient with a history of prostate cancer status post radiation, now being treated with combination therapy with pembrolizumab and carboplatin-pemetrexed for advanced lung adenocarcinoma. Our case emphasizes the importance of being cognizant of TAD and its associations, particularly in cancer patients.
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Affiliation(s)
- Chiara Sabbadini
- Department of Dermatology, Venereology and Allergology, Hospital Brunico, Brunico
| | - Julia Oberschmied
- Department of Dermatology, Venereology and Allergology, Hospital Brunico, Brunico
| | - Martina Tauber
- Department of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Carla Nobile
- Department of Dermatology, Venereology and Allergology, Hospital Brunico, Brunico
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The master of masquerade: A case series of unusual presentations of cutaneous tuberculosis in the immunocompromised host. Indian J Tuberc 2021; 68:540-543. [PMID: 34752327 DOI: 10.1016/j.ijtb.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022]
Abstract
Cutaneous tuberculosis is known for its varied presentations, especially in the setting of immunosuppression. Clinical manifestations can be modified by the site of involvement as well as the type of cutaneous tuberculosis in a particular patient. Although cutaneous tuberculosis only accounts for a small percentage (1-2%) of extrapulmonary cases, it is encountered fairly frequently in dermatology practice in an endemic country like India. These cases are being presented to highlight unusual presentations of well-known forms of cutaneous TB (TB gumma and erythema induratum of Bazin) and rare morphologies (panniculitis) in immunosuppressed individuals, thereby emphasizing the need for the dermatologist in a TB-endemic country to be constantly vigilant.
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Alam MA, Ahmed MN, Khan AH, Arafat SM. Metastatic tuberculous abscess: A rare manifestation of cutaneous tuberculosis. IDCases 2021; 26:e01257. [PMID: 34485079 PMCID: PMC8399307 DOI: 10.1016/j.idcr.2021.e01257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 11/27/2022] Open
Abstract
Cutaneous tuberculosis (CTB), a rare manifestation of tuberculosis is one of the most challenging diagnoses to establish. Metastasic tuberculous abscess is a form of CTB which is characterized by cold abscesses on the patient's extremities or trunk without any involvement of underlying tissue. Here we report a case of 56-year-old Bangladeshi male with no previous history of TB, who presented with multiple abscesses over the body for 3 months. His diagnosis was confirmed on the basis of demonstration of Mycobacterium tuberculosis in the lesions by staining, PCR and culture. But no primary focus was found. After 1 month of anti-tubercular therapy, significant improvement was noted.
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Affiliation(s)
- M A Alam
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Abed Hussain Khan
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shohael Mahmud Arafat
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena M, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín J, Ríos-Viñuela E, Rodríguez Peralto J, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda J, Velasco Benito V, Beato Merino M, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses — Part 2. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Lopes LGF, Carvalho EM, Sousa EHS. A bioinorganic chemistry perspective on the roles of metals as drugs and targets against Mycobacterium tuberculosis - a journey of opportunities. Dalton Trans 2021; 49:15988-16003. [PMID: 32583835 DOI: 10.1039/d0dt01365j] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Medicinal inorganic chemists have provided many strategies to tackle a myriad of diseases, pushing forward the frontiers of pharmacology. As an example, the fight against tuberculosis (TB), an infectious bacterial disease, has led to the development of metal-based compounds as potential drugs. This disease remains a current health issue causing over 1.4 million of deaths per year. The emergence of multi- (MDR) and extensively-drug resistant (XDR) Mycobacterium tuberculosis (Mtb) strains along with a long dormancy process, place major challenges in developing new therapeutic compounds. Isoniazid is a front-line prodrug used against TB with appealing features for coordination chemists, which have been explored in a series of cases reported here. An isoniazid iron-based compound, called IQG-607, has caught our attention, whose in vitro and in vivo studies are advanced and thoroughly discussed, along with other metal complexes. Isoniazid is inactive against dormant Mtb, a hard to eliminate state of this bacillus, found in one-fourth of the world's population and directly implicated in the lengthy treatment of TB (ca. 6 months). Thus, our understanding of this phenomenon may lead to a rational design of new drugs. Along these lines, we describe how metals as targets can cross paths with metals used as selective therapeutics, where we mainly review heme-based sensors, DevS and DosT, as a key system in the Mtb dormancy process and a current drug target. Overall, we report new opportunities for bioinorganic chemists to tackle this longstanding and current threat.
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Affiliation(s)
- Luiz G F Lopes
- Group of Bioinorganic, Department of Organic and Inorganic Chemistry, Federal University of Ceará, Fortaleza, Brazil.
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Yang K, Li T, Zhu X, Zou Y, Liu D. Erythema induratum of Bazin as an indicative manifestation of cavitary tuberculosis in an adolescent: a case report. BMC Infect Dis 2021; 21:747. [PMID: 34344358 PMCID: PMC8335867 DOI: 10.1186/s12879-021-06454-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Erythema induratum of Bazin (EIB) is a rare cutaneous manifestation of tuberculosis (TB) that frequently occurs in middle-aged women. The clinical manifestations of EIB can mimic various skin diseases, easily leading to misdiagnosis or underdiagnosis. We report a case of a 16-year-old Chinese girl who initially presented with EIB and was subsequently diagnosed with cavitary TB. CASE PRESENTATION The patient is a 16-year-old Chinese girl who presented with clusters of erythematous subcutaneous nodules on the posterior part of her right lower leg matching the clinical manifestations of EIB but was otherwise asymptomatic. The patient was subsequently diagnosed with cavitary TB on the basis of a positive result from a T-SPOT.TB test and the observation of cavitary lung lesions in chest computed tomography scanning. A good clinical response was observed in the patient after the initial phase of a standard 6-month antibiotic regimen. CONCLUSIONS Adolescents infected with Mycobacterium tuberculosis frequently present atypical symptoms. Cutaneous manifestations of tuberculosis in adolescents can be considered good clinical indicators to predict the underlying disease. Strong clinical suspicion is required for a prompt diagnosis in adolescents with EIB.
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Affiliation(s)
- Kun Yang
- Department of Dermatology and Venereology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Tingying Li
- Department of Dermatology and Venereology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Xiaomei Zhu
- Department of Dermatology and Venereology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Yun Zou
- Department of Dermatology and Venereology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Dongxian Liu
- Department of Dermatology and Venereology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
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38
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Wedy GF, Passero LFD, Criado PR, Belda W. A case of tuberculosis verrucosa cutis in Brazil undiagnosed for 15 years. Braz J Infect Dis 2021; 25:101593. [PMID: 34242596 PMCID: PMC9392159 DOI: 10.1016/j.bjid.2021.101593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/06/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis verrucosa cutis is a rare medical condition that is caused by the inoculation of Mycobacterium tuberculosis into the skin of a previously sensitized individual. This clinical form of tuberculosis corresponds to 1-2% of all cases of tuberculosis and due to the paucibacillary characteristic of the lesions, patients can be misdiagnosed, accounting for the chronification of the skin infection. Herein, we report the case of a 26-year-old male farmer, presenting plaques with verrucosa and hyperkeratosis features in the left thigh and buttocks during 15 years. M. tuberculosis was identified by PCR and the patient was treated with standard anti-tuberculosis drugs, with subsequent improvement of the skin lesions.
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Affiliation(s)
| | - Luiz Felipe Domingues Passero
- São Paulo State University (UNESP), Institute of Biosciences, São Vicente, SP, Brazil; São Paulo State University (UNESP), Institute for Advanced Studies of Ocean, São Vicente, SP, Brazil
| | - Paulo Ricardo Criado
- Fundação Universitária do ABC (FUABC), ABC School of Medicine, Santo André, SP, Brazil
| | - Walter Belda
- University of São Paulo, Medical School, Clinics Hospital, São Paulo, SP, Brazil; University of São Paulo, Medical School, Laboratory of Pathology of Infectious Diseases, São Paulo, SP, Brazil.
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Djawad K, Wahab S, Massi N. Coexistence of tuberculous chancre on a chronic nonhealing wound and bilateral submandibular scrofuloderma. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2021. [DOI: 10.15570/actaapa.2021.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Razack R, Claasens S, Schubert PT, van Zyl A. Myth or mycobacterium? Negative image cytology revisited in a case of an atypical mycobacterial cutaneous infection. Diagn Cytopathol 2021; 49:1059-1062. [PMID: 34191403 DOI: 10.1002/dc.24820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Rubina Razack
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Saskya Claasens
- Department of Dermatology, Tygerberg Hospital, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Pawel T Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Adri van Zyl
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
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Cutaneous tuberculosis simultaneously presenting as a subcutaneous nodule and mass: A case report. IDCases 2021; 25:e01207. [PMID: 34307044 PMCID: PMC8258638 DOI: 10.1016/j.idcr.2021.e01207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/26/2021] [Accepted: 06/26/2021] [Indexed: 11/20/2022] Open
Abstract
Although the incidence of tuberculosis (TB) is decreasing globally, it remains an endemic disease in Taiwan. The etiology of cutaneous TB can be endogenous or exogenous. The mechanism of infection could be direct inoculation, contiguity, or hematogenous dissemination. The clinical manifestations are diverse, ranging from scrofuloderma, acute miliary TB, tuberculous chancre, tuberculosis verrucosa cutis, and lupus vulgaris to tuberculid. Basis the bacterial load, cutaneous TB is classified as multibacillary or paucibacillary. We present a case of cutaneous TB that initially presented as a subcutaneous nodule and a mass. The cutaneous TB likely originated from underlying TB lymphadenitis and TB spine and presented as scrofuloderma.
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Gao LJ, Huang ZH, Jin QY, Zhang GY, Gao MX, Qian JY, Zhu SX, Yu Y. Delayed diagnosis and comprehensive treatment of cutaneous tuberculosis: A case report. World J Clin Cases 2021; 9:4007-4015. [PMID: 34141760 PMCID: PMC8180233 DOI: 10.12998/wjcc.v9.i16.4007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/07/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a widespread infectious disease, with an incidence that is increasing worldwide. Cutaneous TB (CTB) occurs rarely, accounting for less than 1% of all TB cases. Due to the clinical presentation and diagnostic difficulties, CTB is often clinically neglected and misdiagnosed.
CASE SUMMARY A 32-year-old man underwent several debridement surgeries and skin flap transplantation after trauma. The wound remained unhealed, accompanied by sinus formation. According to empirical judgment, T-cell spot of TB test, and bacterial culture of pyogenic fluids, he was diagnosed with CTB due to infection with exogenous Mycobacterium tuberculosis. A comprehensive anti-TB regimen that included isoniazid, rifampicin, ethambutol, and pyrazinamide was applied. The sinus was filled with a hydrophilic fiber-containing silver dressing, and wound-protecting sponges were applied to part of the wound. The wound healed after 40 d. No ulceration was found within 2 mo after discharge; further follow-up will be conducted.
CONCLUSION A non-healing wound may be caused by TB infection. Comprehensive treatment of CTB is effective.
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Affiliation(s)
- Lu-Jue Gao
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Zi-Hui Huang
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Quan-Yong Jin
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Guo-Ying Zhang
- Department of Laboratory, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Min-Xing Gao
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Jia-Yan Qian
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Si-Xun Zhu
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Yang Yu
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
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43
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Extrapulmonary Tuberculosis—An Update on the Diagnosis, Treatment and Drug Resistance. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pathogenic Mycobacterium tuberculosis complex organisms (MTBC) primarily cause pulmonary tuberculosis (PTB); however, MTBC are also capable of causing disease in extrapulmonary (EP) organs, which pose a significant threat to human health worldwide. Extrapulmonary tuberculosis (EPTB) accounts for about 20–30% of all active TB cases and affects mainly children and adults with compromised immune systems. EPTB can occur through hematogenous, lymphatic, or localized bacillary dissemination from a primary source, such as PTB, and affects the brain, eye, mouth, tongue, lymph nodes of neck, spine, bones, muscles, skin, pleura, pericardium, gastrointestinal, peritoneum, and the genitourinary system as primary and/or disseminated disease. EPTB diagnosis involves clinical, radiological, microbiological, histopathological, biochemical/immunological, and molecular methods. However, only culture and molecular techniques are considered confirmatory to differentiate MTBC from any non-tuberculous mycobacteria (NTM) species. While EPTB due to MTBC responds to first-line anti-TB drugs (ATD), drug susceptibility profiling is an essential criterion for addressing drug-resistant EPTB cases (DR-EPTB). Besides antibiotics, adjuvant therapy with corticosteroids has also been used to treat specific EPTB cases. Occasionally, surgical intervention is recommended, mainly when organ damage is debilitating to the patient. Recent epidemiological studies show a striking increase in DR-EPTB cases ranging from 10–15% across various reports. As a neglected disease, significant developments in rapid and accurate diagnosis and better therapeutic interventions are urgently needed to control the emerging EPTB situation globally. In this review, we discuss the recent advances in the clinical diagnosis, treatment, and drug resistance of EPTB.
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Bittencourt TL, da Silva Prata RB, de Andrade Silva BJ, de Mattos Barbosa MG, Dalcolmo MP, Pinheiro RO. Autophagy as a Target for Drug Development Of Skin Infection Caused by Mycobacteria. Front Immunol 2021; 12:674241. [PMID: 34113346 PMCID: PMC8185338 DOI: 10.3389/fimmu.2021.674241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022] Open
Abstract
Pathogenic mycobacteria species may subvert the innate immune mechanisms and can modulate the activation of cells that cause disease in the skin. Cutaneous mycobacterial infection may present different clinical presentations and it is associated with stigma, deformity, and disability. The understanding of the immunopathogenic mechanisms related to mycobacterial infection in human skin is of pivotal importance to identify targets for new therapeutic strategies. The occurrence of reactional episodes and relapse in leprosy patients, the emergence of resistant mycobacteria strains, and the absence of effective drugs to treat mycobacterial cutaneous infection increased the interest in the development of therapies based on repurposed drugs against mycobacteria. The mechanism of action of many of these therapies evaluated is linked to the activation of autophagy. Autophagy is an evolutionary conserved lysosomal degradation pathway that has been associated with the control of the mycobacterial bacillary load. Here, we review the role of autophagy in the pathogenesis of cutaneous mycobacterial infection and discuss the perspectives of autophagy as a target for drug development and repurposing against cutaneous mycobacterial infection.
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Affiliation(s)
| | | | | | | | - Margareth Pretti Dalcolmo
- Helio Fraga Reference Center, Sergio Arouca National School of Public Health, Fiocruz, Rio de Janeiro, Brazil
| | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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Arkell P, Florindo TE, Baird R, Babua C. Chronic suppurative skin lesions in a young woman. BMJ 2021; 373:n797. [PMID: 33883148 DOI: 10.1136/bmj.n797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Paul Arkell
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor Leste
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Tanizio E Florindo
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor Leste
| | - Rob Baird
- Territory Pathology, Darwin, Australia
| | - Christopher Babua
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor Leste
- Royal Australasian College of Surgeons, Melbourne, Australia
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MA, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda JM, Velasco Benito V, Beato Merino MJ, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 2. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00138-1. [PMID: 33891884 DOI: 10.1016/j.ad.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022] Open
Abstract
Part 2 of this series on granulomatous diseases focuses on skin biopsy findings. Whereas the first part treated noninfectious conditions (metabolic disorders and tumors, among other conditions), this part mainly deals with various types of infectious disease along with other conditions seen fairly often by clinical dermatologists.
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Affiliation(s)
- J Aróstegui Aguilar
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Carrillo Gijón
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Fernández Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, España
| | - M Garrido
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - M A Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - A Christian Laga
- Departamento de Patología, Brigham and Women's Hospital, Boston, Massachusetts, Estados Unidos
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - N Martínez Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Sant Joan d'Alacant, Alicante, España
| | - N Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Quirón salud, Sant Cugat del Vallès, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - A Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica. Hospital Universitario Son Espases, Palma de Mallorca, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | - A Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, León, España; Unidad de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
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Kim JW, Yoo JR, Oh H, Kim M, Heo ST. Delayed Diagnosis of Tuberculosis Mistaken for Tinea Corporis in a Healthy Adult. Tuberc Respir Dis (Seoul) 2021; 84:245-246. [PMID: 33853296 PMCID: PMC8273017 DOI: 10.4046/trd.2021.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jae-Wang Kim
- Department of Dermatology, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jeong Rae Yoo
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Hyunjoo Oh
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Misun Kim
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
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48
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Malek AE, Fife CE, Rasmussen JC, Karni RJ, Morrow JR, Wanger A, Sevick-Muraca EM, Ostrosky-Zeichner L. Lymphatic Dissemination and Axillary Web Syndrome in Primary Cutaneous Tuberculosis Secondary to Needlestick Injury. Open Forum Infect Dis 2021; 8:ofab160. [PMID: 34322561 PMCID: PMC8312518 DOI: 10.1093/ofid/ofab160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/25/2021] [Indexed: 11/14/2022] Open
Abstract
Cutaneous tuberculosis secondary to skin inoculation of Mycobacterium tuberculosis is uncommon but it can occur in the health care settings. Herein, we report an unusual case of primary cutaneous tuberculosis of the thumb following a needlestick injury. The infection progressed with a necrotic granuloma, lymphatic dysfunction as visualized by near-infrared fluorescence lymphatic imaging, and the development of an axillary web syndrome.
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Affiliation(s)
- Alexandre E Malek
- Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caroline E Fife
- Department of Geriatrics, Baylor College of Medicine, Houston, Texas, USA.,CHI St Luke's Hospital, The Woodlands, Texas, USA
| | - John C Rasmussen
- Center for Molecular Imaging, Brown Foundation Institute for Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ron J Karni
- Department of Otorhinolaryngology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John R Morrow
- Center for Molecular Imaging, Brown Foundation Institute for Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Audrey Wanger
- Department of Microbiology and Molecular Genetics, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Eva M Sevick-Muraca
- Center for Molecular Imaging, Brown Foundation Institute for Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Luis Ostrosky-Zeichner
- Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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49
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Cutaneous Mycobacterial Infections in Returning Travelers. CURRENT TROPICAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40475-021-00228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Kunciw SE, de la Cruz EC. Incidental Finding of Tuberculosis During Evaluation for Delayed Wound Healing. Mil Med 2021; 186:e457-e460. [PMID: 33007072 DOI: 10.1093/milmed/usaa366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/10/2020] [Accepted: 09/10/2020] [Indexed: 11/14/2022] Open
Abstract
Cutaneous tuberculosis (TB) is an uncommon form of extrapulmonary TB that can be difficult to diagnose. The following case is about a 14-year-old female who was experiencing delayed wound healing after an incision and drainage of a chest wall abscess. A computed tomography scan of her chest obtained 2 months after the procedure revealed pulmonary findings consistent with TB. An acid-fast bacilli culture was obtained from the wound after the computed tomography scan was performed and was positive for Mycobacterium tuberculosis 8 weeks later. Although TB is relatively uncommon in the United States, it is more prevalent in the Republic of Korea where the patient lives and was evaluated. This case serves to illustrate the long history of challenges the military medical community has faced with TB and to remind providers to be cognizant about local common diseases when serving overseas and include these diagnoses in their differentials.
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Affiliation(s)
- Sabrina E Kunciw
- Department of Family Medicine and Department of Surgery, Brian D. Allgood Army Community Hospital, U.S. Army Garrison Humphreys, 549th Hospital Center Unit #15245, APO, AP, 96271-5245, South Korea
| | - Eric C de la Cruz
- Department of Family Medicine and Department of Surgery, Brian D. Allgood Army Community Hospital, U.S. Army Garrison Humphreys, 549th Hospital Center Unit #15245, APO, AP, 96271-5245, South Korea
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