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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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2
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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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3
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Fever, ascites and rugged skin lesions. J Paediatr Child Health 2022; 58:932. [PMID: 35499940 DOI: 10.1111/jpc.2_15624] [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: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
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4
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Mizuta T, Kato M. Ulcerative Lupus Vulgaris on the Wrist. Case Rep Dermatol 2021; 13:428-431. [PMID: 34594202 PMCID: PMC8436606 DOI: 10.1159/000514942] [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: 12/13/2020] [Accepted: 02/02/2021] [Indexed: 11/19/2022] Open
Abstract
We report a case of ulcerative lupus vulgaris (LV) in a unique site, which facilitated the detection of internal organ tuberculosis (TB). A 68-year-old Japanese man presented with a reddish ulcerated painless lesion on his right wrist that had initially appeared 4 weeks earlier as a nontender nodule. There was no recent history of fever, weight loss, or cough. The results of tissue culture, PCR, and contrast-enhanced chest computed tomography were consistent with the diagnosis of ulcerative LV with underlying pulmonary TB and tuberculous lymphadenitis. The patient was started on anti-TB therapy. After 1 month of therapy, epithelialization of the ulcer was noted.
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Affiliation(s)
- Takahiro Mizuta
- Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Tokyo, Japan
| | - Miyuki Kato
- Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Tokyo, Japan
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5
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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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6
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Sen Sarma M, Yachha SK. Fever, ascites and rugged skin lesions. J Paediatr Child Health 2021:jpc.15624. [PMID: 34181794 DOI: 10.1111/jpc.15624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Surender K Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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7
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Othman SA, ElSharkawy TM, Alfaifi D, Aljehani Y. The Effectiveness of Vacuum-Assisted Closure Device in Managing Intramuscular Tuberculosis. Adv Skin Wound Care 2021; 34:330-333. [PMID: 33958522 DOI: 10.1097/01.asw.0000744328.95568.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Tuberculosis (TB) is endemic to some geographic areas such as Africa, Eastern Europe, Asia, Latin America, and the Caribbean. It is called the great mimicker because of its diverse and variable presentation and affects almost every organ in the body with different symptomatology. Often, TB causes empyema necessitans, the rarest forms of which are intramuscular and cutaneous. Here, the authors report a case of empyema necessitans and intramuscular TB, which was managed successfully with negative-pressure wound therapy. The treatment provided a good outcome and patient satisfaction compared with traditional invasive surgical options.
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Affiliation(s)
- Sharifah A Othman
- At the King Fahad Hospital, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia, Sharifah A. Othman, MBBS, is Surgery Resident, Thoracic Surgery Division; Tarek M. ElSharkawy, MD, is Pathology Consultant, Pathology Department; Doaa Alfaifi, MD, is Pathology Resident, Pathology Department; and Yasser Aljehani, MD, is Thoracic Surgery Consultant, Thoracic Surgery Division. Acknowledgment: The authors thank Dr Wasan Alalwan for collecting the patient's data. The authors have disclosed no financial relationships related to this article. Submitted May 28, 2020; accepted in revised form July 7, 2020
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Abstract
Humans encounter mycobacterial species due to their ubiquity in different environmental niches. In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. Cutaneous mycobacterial infections may cause a wide range of clinical manifestations, which are divided into four main disease categories: (i) cutaneous manifestations of Mycobacterium tuberculosis infection, (ii) Buruli ulcer caused by Mycobacterium ulcerans and other related slowly growing mycobacteria, (iii) leprosy caused by Mycobacterium leprae and Mycobacterium lepromatosis, and (iv) cutaneous infections caused by rapidly growing mycobacteria. Clinically, cutaneous mycobacterial infections present with widely different clinical presentations, including cellulitis, nonhealing ulcers, subacute or chronic nodular lesions, abscesses, superficial lymphadenitis, verrucous lesions, and other types of findings. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Cutaneous tuberculosis exhibits different clinical phenotypes acquired through different routes, including via extrinsic inoculation of the tuberculous bacilli and dissemination to the skin from other sites, or represents hypersensitivity reactions to M. tuberculosis infection. In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. Mycobacterium lepromatosis, a mycobacterial species related to M. leprae, is linked to diffuse lepromatous leprosy of Lucio and Latapí. Mycobacterium ulcerans produces a mycolactone toxin that leads to subcutaneous tissue destruction and immunosuppression, resulting in deep ulcerations that often produce substantial disfigurement and disability. Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Among patients with advanced immunosuppression, Mycobacterium kansasii, the Mycobacterium avium-intracellulare complex, and Mycobacterium haemophilum may cause cutaneous or disseminated disease. Rapidly growing mycobacteria, including the Mycobacterium abscessus group, Mycobacterium chelonei, and Mycobacterium fortuitum, are increasingly recognized pathogens in cutaneous infections associated particularly with plastic surgery and cosmetic procedures. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Additionally, histopathological evaluation of skin biopsy specimens may be useful in identifying leprosy, Buruli ulcer, and cutaneous tuberculosis. Molecular assays are useful in some cases. The treatment for cutaneous mycobacterial infections depends on the specific pathogen and therefore requires a careful consideration of antimicrobial choices based on official treatment guidelines.
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Zhang J, Fan Y, Wang P, Chen Q, Wang G, Xu A, Chen L, Hu R, Chen W, Song Z, Hao F. Cutaneous tuberculosis in China - A multicentre retrospective study of cases diagnosed between 1957 and 2013. J Eur Acad Dermatol Venereol 2018; 32:632-638. [PMID: 29476577 DOI: 10.1111/jdv.14851] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. Zhang
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - Y.K. Fan
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - P. Wang
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - Q.Q. Chen
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - G. Wang
- Department of Dermatology and Venereology; Xijing Hospital; Forth Military Medical University; Xi'an China
| | - A.E. Xu
- Department of Dermatology and Venereology; Third People's Hospital of Hangzhou; Hangzhou China
| | - L.Q. Chen
- Department of Dermatology and Venereology; First People's Hospital of Wuhan; Wuhan China
| | - R. Hu
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - W. Chen
- IZZ Immunologie-Zentrum Zürich; Zurich Switzerland
- Department of Dermatology and Allergy; Technische Universität München; Munich Germany
| | - Z.Q. Song
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - F. Hao
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
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10
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McLachlan I, Visser WI, Jordaan HF. Skin conditions in a South African tuberculosis hospital: Prevalence, description, and possible associations. Int J Dermatol 2017; 55:1234-1241. [PMID: 27419379 DOI: 10.1111/ijd.13355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 01/20/2016] [Accepted: 03/20/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The current pandemic of tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection, the modern era of antiretroviral therapy, and the rising incidence of multidrug-resistant TB have led to a broader spectrum of skin conditions in patients hospitalized with TB. These factors also influence investigations into possible causal relationships with TB. OBJECTIVES The aim of this study was to describe mucocutaneous conditions found in patients hospitalized with TB and to report associated factors. METHODS A cross-sectional observational study examining the spectrum of skin manifestations found in 105 patients hospitalized with TB was conducted. All relevant demographic and clinical data were collected. Possible associations were evaluated by making use of statistical analysis. RESULTS Seventy-four (70%) of the investigated population were HIV-positive, and 46 (44%) patients were being treated for drug-resistant TB. The most prevalent dermatosis was xerosis (n = 83, 79%), followed by oral candidiasis (n = 33, 31%) and scars (n = 33, 31%), finger clubbing (n = 31, 29%), leukonychia (n = 29, 28%), striae (n = 25, 24%), and facial hyperpigmentation (n = 22, 21%). Anemia was detected in 90 (86%) patients, and 75 (71%) were classified as being underweight. Three patients were diagnosed with cutaneous TB. CONCLUSIONS Patients hospitalized with TB have on average four different dermatoses, but xerosis remains the leading dermatological finding, irrespective of HIV status or TB drug sensitivity. Anemia and malnutrition are associated with numerous skin conditions found in this population. The prevalence of cutaneous TB among patients hospitalized with TB remains low, despite the high rate of TB and HIV co-infection.
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Affiliation(s)
- Iréne McLachlan
- Division of Dermatology, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa.
| | - Willem I Visser
- Division of Dermatology, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa
| | - H Francois Jordaan
- Division of Dermatology, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa
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11
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Peters F, Batinica M, Plum G, Eming SA, Fabri M. Keim oder kein Keim: Herausforderungen bei der Diagnose mykobakterieller Infektionen der Haut. J Dtsch Dermatol Ges 2016; 14:1227-1236. [PMID: 27992147 DOI: 10.1111/ddg.13001_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/19/2016] [Indexed: 11/28/2022]
Abstract
Kutane Mykobakteriosen sind in Deutschland selten. Dennoch ist es für eine frühzeitige Diagnose und anschließende wirksame Behandlung erforderlich, dass diese Krankheitsbilder im ärztlichen Bewusstsein verankert sind. Darüber hinaus stehen Infektionen mit Mykobakterien auf der Liste der Differentialdiagnosen vieler Hautkrankheiten. Diagnosen kutaner Mykobakteriosen beruhen auf klinischen Merkmalen und auf Laboruntersuchungen, einschließlich bakterieller Kulturen, histopathologischer Untersuchungen und PCR-basierten Verfahren. Das Wissen um Möglichkeiten und Grenzen dieser Laboruntersuchungen ist von zentraler Bedeutung, um eine angemessene klinische Entscheidung zu treffen. In diesem Beitrag diskutieren wir die aktuellen diagnostischen Möglichkeiten, die in Verdachtsfällen kutaner Mykobakteriosen zur Verfügung stehen.
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Affiliation(s)
- Franziska Peters
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität Köln, Deutschland
| | - Marina Batinica
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität Köln, Deutschland
| | - Georg Plum
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Köln, Deutschland
| | - Sabine A Eming
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität Köln, Deutschland.,Zentrum für Molekulare Medizin Köln, Universität Köln, Deutschland
| | - Mario Fabri
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität Köln, Deutschland.,Zentrum für Molekulare Medizin Köln, Universität Köln, Deutschland
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12
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Amraoui N, Krich S, Meziane M, Gallouj S, Abid H, Elmrini A, Moumna K, Harmouch T, Mernissi F. Cutaneous tuberculosis revealing multifocal tuberculosis in immunocompetent patients. Int J Mycobacteriol 2016; 4:255-7. [PMID: 27649875 DOI: 10.1016/j.ijmyco.2015.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 05/08/2015] [Accepted: 05/09/2015] [Indexed: 11/17/2022] Open
Abstract
Multifocal tuberculosis (TB) is rare. It occurs especially in immunocompromised patients. Association with skin involvement is rarer, and few cases are reported in the literature. The present study reports 7 cases of multifocal TB with cutaneous localization in immunocompetent patients. Cutaneous forms of TB included in this series are: gummas, scrofuloderma, vasculitis TB and lupus TB. The patients had at least two extra skin locations, namely: osteoarticular, lung, pleural, scrotal, muscular, digestive, laryngeal, nodal and splenic locations. These patients had no context of immunosuppression which is uncommon, but should be kept in mind, especially in endemic countries.
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Affiliation(s)
- N Amraoui
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco.
| | - S Krich
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco
| | - M Meziane
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco
| | - S Gallouj
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco
| | - H Abid
- Department of Orthopedy and Traumatology B4, Hassan II University Hospital Fez, Morocco
| | - A Elmrini
- Department of Orthopedy and Traumatology B4, Hassan II University Hospital Fez, Morocco
| | - K Moumna
- Department of Pathology, Hassan II University Hospital Fez, Morocco
| | - T Harmouch
- Department of Pathology, Hassan II University Hospital Fez, Morocco
| | - F Mernissi
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco
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13
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Peters F, Batinica M, Plum G, Eming SA, Fabri M. Bug or no bug: challenges in diagnosing cutaneous mycobacterial infections. J Dtsch Dermatol Ges 2016; 14:1227-1235. [DOI: 10.1111/ddg.13001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/19/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Franziska Peters
- Department of Dermatology; University of Cologne; Cologne Germany
| | - Marina Batinica
- Department of Dermatology; University of Cologne; Cologne Germany
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene; University Hospital of Cologne; Cologne Germany
| | - Sabine A. Eming
- Department of Dermatology; University of Cologne; Cologne Germany
- Center for Molecular Medicine Cologne; University of Cologne; Cologne Germany
| | - Mario Fabri
- Department of Dermatology; University of Cologne; Cologne Germany
- Center for Molecular Medicine Cologne; University of Cologne; Cologne Germany
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14
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Spelta K, Diniz LM. CUTANEOUS TUBERCULOSIS: A 26-YEAR RETROSPECTIVE STUDY IN AN ENDEMIC AREA OF TUBERCULOSIS, VITÓRIA, ESPÍRITO SANTO, BRAZIL. Rev Inst Med Trop Sao Paulo 2016; 58:49. [PMID: 27410909 PMCID: PMC4964318 DOI: 10.1590/s1678-9946201658049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/20/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Tuberculosis is a serious health problem in Brazil so that the knowledge on the aspects of cutaneous tuberculosis is medically important. OBJECTIVE To assess the characteristics of patients with cutaneous tuberculosis treated at the Cassiano Antonio Moraes University Hospital, located in the city of Vitória, State of Espírito Santo, Brazil. METHODS This is a retrospective, descriptive, observational and cross-sectional study using the medical records of 29 patients with cutaneous tuberculosis treated at the Dermatology and Pulmonology services of the hospital from 1986 to 2011. The inclusion criterion was the confirmation of cutaneous tuberculosis taking into account clinical, epidemiological, immunological, and bacteriological findings, as well as the response to specific treatment. RESULTS Of the 29 studied patients; 18 (62%) were women with average age of 37 years; the predominant clinical condition was erythema induratum of Bazin in 12 (41.4%) cases; and the cutaneous lesions were in the lower limbs in 19 (65.8%) patients. Extra-cutaneous involvement occurred in eight (27.6%) cases. The tuberculin tests were positive in 15 (79%) individuals and the assessment of the infectious agent was negative in most of the investigated cases. CONCLUSION The study found a low frequency (0.44%) of cutaneous tuberculosis in an endemic area of tuberculosis. There was a predominance of infection in women aged thirty to forty years. Erythema induratum was the most common clinical condition, affecting mainly the lower limbs, in contrast to other Brazilian studies that found scrofuloderma as the most common manifestation, predominating in the cervical region of male children and adolescents.
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Affiliation(s)
- Karla Spelta
- Federal University of Espírito Santo, Medical Graduate Program. Vitória, ES, Brazil
| | - Lucia M Diniz
- Federal University of Espírito Santo, Medical Graduate Program. Vitória, ES, Brazil
- Federal University of Rio de Janeiro, Medical Graduate Program. Rio de Janeiro, RJ, Brazil
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15
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Scollard DM, Dacso MM, Abad-Venida ML. Tuberculosis and Leprosy: Classical Granulomatous Diseases in the Twenty-First Century. Dermatol Clin 2016; 33:541-62. [PMID: 26143431 DOI: 10.1016/j.det.2015.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Leprosy and tuberculosis are chronic mycobacterial infections that elicit granulomatous inflammation. Both infections are curable, but granulomatous injury to cutaneous structures, including cutaneous nerves in leprosy, may cause permanent damage. Both diseases are major global concerns: tuberculosis for its high prevalence and mortality, and leprosy for its persistent global presence and high rate of neuropathic disability. Cutaneous manifestations of both leprosy and tuberculosis are frequently subtle and challenging in dermatologic practice and often require a careful travel and social history and a high index of suspicion.
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Affiliation(s)
- David M Scollard
- National Hansen's Disease Programs, 1770 Physician Park Drive, Baton Rouge, LA 70816, USA.
| | - Mara M Dacso
- Center for Dermatology and Cosmetic Laser Surgery, 5026 Tennyson Parkway, Plano, TX 75024, USA; Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9069, USA
| | - Ma Luisa Abad-Venida
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Rizal Avenue, Manila 1008, Philippines
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16
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Sellami K, Boudaya S, Chaabane H, Amouri M, Masmoudi A, Mseddi M, Turki H. Twenty-nine cases of lupus vulgaris. Med Mal Infect 2016; 46:93-5. [DOI: 10.1016/j.medmal.2015.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 09/13/2015] [Accepted: 12/17/2015] [Indexed: 11/27/2022]
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17
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Basal Y, Ermişler B, Eryilmaz A, Ertuğrul B. Two rare cases of head and neck tuberculosis. BMJ Case Rep 2015; 2015:bcr-2015-211897. [PMID: 26498669 DOI: 10.1136/bcr-2015-211897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tuberculosis is an infectious disease, which is the leading cause of mortality and morbidity and is still a serious health concern. The fact that extra pulmonary tuberculosis does not have specific examination and radiographic findings and that clinical findings vary depending on the organ in which it is detected cause diagnostic difficulties. The head and neck region is an uncommon site for tuberculosis and tuberculosis can localise in many different places of the head and neck region. In this article, the authors present a case of nasopharyngeal tuberculosis, which clinically mimics nasopharyngeal carcinoma and rare cutaneous tuberculosis of the pinna. A wide knowledge of head and neck tuberculosis, including the disease in the differential diagnosis and carrying out microbiological examinations are necessary for accurate diagnosis.
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Affiliation(s)
- Yesim Basal
- Department of Otorhinolaryngology, Adnan Menderes University, Aydın, Turkey
| | - Barış Ermişler
- Department of Otorhinolaryngology, Adnan Menderes University, Aydın, Turkey
| | - Aylin Eryilmaz
- Department of Otorhinolaryngology, Adnan Menderes University, Aydın, Turkey
| | - Bülent Ertuğrul
- Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University, Aydın, Turkey
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Lo Schiavo A, Caccavale S, Schiavone M, Alfano R, Cozzi R. Scrofuloderma: a forgotten disease? J Cutan Med Surg 2013; 17:82-3. [PMID: 23582161 DOI: 10.2310/7750.2013.12106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Küçükünal A, Ekmekçi TR, Sakız D. "Turkey ear" as a cutaneous maniestation of tuberculosis. Indian J Dermatol 2012; 57:504. [PMID: 23248385 PMCID: PMC3519274 DOI: 10.4103/0019-5154.103088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lupus vulgaris is the most common morphological variant of cutaneous tuberculosis. Classical lupus lesions are often seen in the head and neck region. Turkey ear is a clinically descriptive term, previously being used for the earlobe with reddish indurated plaque lesions, which recently can be a sign for lupus vulgaris. A 65-year-old man presented with lupus vulgaris of the earlobe. The diagnosis was confirmed by conventional laboratory investigations and the patient showed well response to antituberculous therapy. This is the second reported case of “turkey ear” as a manifestation of cutaneous tuberculosis.
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Affiliation(s)
- Aslı Küçükünal
- Department of Dermatology, Şişli Etfal Training and Research Hospital, Istanbul, Turkey
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Kim GW, Park HJ, Kim HS, Kim SH, Ko HC, Kim BS, Kim MB, Sim EK. Delayed diagnosis of scrofuloderma misdiagnosed as a bacterial abscess. Ann Dermatol 2012; 24:70-3. [PMID: 22363159 PMCID: PMC3283855 DOI: 10.5021/ad.2012.24.1.70] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/07/2010] [Accepted: 10/07/2010] [Indexed: 11/08/2022] Open
Abstract
An 82-year-old woman presented with a four-month history of an ulcerative plaque overlying her left neck. This lesion had developed as a subcutaneous nodule, gradually increased in size, and evolved into ulcers. Before visiting our Dermatology clinic, the patient had been diagnosed as having a bacterial abscess, but treatments with antibiotics were unsuccessful. The presence of a purulent discharge and prominent ulceration caused further confusion as bacterial abscess, and radiologic evaluation on computed tomography also led to the possibilities of secondary lesions from an abscess or malignancy. However, the characteristic appearance of her lesion allowed us to discern cutaneous tuberculosis, especially scrofuloderma. Based on clinical examinations, staining for acid-fast bacilli, and positive findings of polymerase chain reaction, a quick diagnosis of scrofuloderma was made. After that, she was treated successfully with anti-tuberculosis therapy and the ulcer healed. Our case highlights the problem of delayed diagnosis of scrofuloderma presenting as a bacterial abscess. In conclusion, having a high index of suspicion is needed to diagnose cutaneous tuberculosis correctly.
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Affiliation(s)
- Gun-Wook Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
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Sezgin B, Atilganoglu U, Yigit O, Ergün SS, Cambaz N, Demirkesen C. Concomitant cutaneous metastatic tuberculous abscesses and multifocal skeletal tuberculosis. Indian J Dermatol 2010; 53:149-53. [PMID: 19882018 PMCID: PMC2763739 DOI: 10.4103/0019-5154.43208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tuberculosis, one of the oldest diseases known to affect humans is caused by the bacteria mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one third of cases, other organs are involved. Metastatic tuberculosis abscess is a rare form of skin tuberculosis. It is characterized by nodule and abscess formation throughout the body after hematogenous spread of mycobacterium tuberculosis from a primary focus during a period of impaired immunity. Tuberculosis osteomyelitis is also a rare form of extrapulmonary tuberculosis in pediatric age group. Skeletal tuberculosis pathogenesis is related to reactivation of hematogenous foci or spread from adjacent paravertebral lymph nodes. Weight-bearing joints are affected most commonly. Bilateral hand and foot bone involvement is rarely reported. We present a five-year-old girl with two very rare presentations of the disease such as osteomyelitis and metastatic skin abscess.
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Affiliation(s)
- Betul Sezgin
- Department of Pediatry, Cerrahpasa Medical School, Istanbul, Turkey
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Ermertcan AT, Öztürk F, Gençoğlan G, İnanir I, Özkütük N, Temiz P. Pott's disease with scrofuloderma and psoas abscess misdiagnosed and treated as hidradenitis suppurativa. J DERMATOL TREAT 2010; 22:52-4. [DOI: 10.3109/09546630903443365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Almaguer-Chávez J, Ocampo-Candiani J, Rendón A. Panorama actual en el diagnóstico de la tuberculosis cutánea. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)71904-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Reich A, Kobierzycka M, Cisło M, Schwartz RA, Szepietowski JC. Psoriasiform lupus vulgaris with 30 years duration. ACTA ACUST UNITED AC 2009; 38:556-8. [PMID: 16798713 DOI: 10.1080/00365540500404045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Lupus vulgaris is a progressive form of cutaneous tuberculosis occurring in a person with a moderate to high degree of immunity. It is the most common type of cutaneous tuberculosis. Lupus vulgaris can be mimicked by several other skin conditions, and a 69-y-old female is described with an extremely long history of extensive infiltrative skin lesions with abundant scaling. The lesions were localized on the right arm and forearm, and on the right lateral surface of the chest. The diascopic test was positive. Moreover, a large atrophic scar was seen in the region of right cubital fossa resulting in contracture of the right elbow joint. The histopathology strongly suggested the diagnosis of tuberculosis. The final diagnosis of tuberculosis was confirmed by PCR examination. A polychemotherapeutic regimen (ethambutol 1250 mg/d, rifampicin 600 mg/d and isoniazid 300 mg/d) was successfully employed for the treatment of skin lesions.
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Affiliation(s)
- Adam Reich
- Department of Dermatology, Venereology and Allergology, University of Medicine, Wroclaw, Poland
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Almaguer-Chávez J, Ocampo-Candiani J, Rendón A. Current Panorama in the Diagnosis of Cutaneous Tuberculosis. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70124-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Cho WC, Pai YC, Hsiung Y, Choi WM. Cutaneous Tuberculosis Presenting as Necrotizing Fasciitis in an Elderly Patient. INT J GERONTOL 2008. [DOI: 10.1016/s1873-9598(08)70016-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hay RJ. Cutaneous tuberculosis and the control of infection in resource-poor environments. Dermatology 2008; 217:94-6. [PMID: 18446033 DOI: 10.1159/000128285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Martins Junior EV, Marques BP, Reis Neto ETD, Lima BCMLDS, Neumann YRB. Tuberculose cutânea disseminada com escrofuloderma associado à tuberculose de arco costal. An Bras Dermatol 2007. [DOI: 10.1590/s0365-05962007000400007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Os autores relatam caso de tuberculose cutânea disseminada com escrofuloderma associado à tuberculose de arco costal. Paciente de 46 anos, do sexo feminino, há um ano com nódulos de um a 6cm em região cervical, dorso, axilas e regiões glúteas, que culminavam com fistulização e eliminação de secreção purulenta, associados a febre vespertina diária, sudorese noturna e emagrecimento de 10kg nos últimos três meses. A radiografia de tórax mostrou lesão lítica na terceira costela esquerda. A cultura de secreção do nódulo foi positiva para Mycobacterium tuberculosis. O tratamento para tuberculose resultou em melhora clínica e resolução das lesões cutâneas da paciente.
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Lai-Cheong JE, Perez A, Tang V, Martinez A, Hill V, Menagé HDP. Cutaneous manifestations of tuberculosis. Clin Exp Dermatol 2007; 32:461-6. [PMID: 17376216 DOI: 10.1111/j.1365-2230.2007.02352.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cutaneous involvement is a rare manifestation of tuberculosis (TB). The correct diagnosis is often significantly delayed because cutaneous TB is not routinely considered in the differential diagnosis or because investigations fail to reveal the presence of Mycobacterium tuberculosis. The clinical features of cutaneous TB are diverse, and result from exogenous and endogenous spread of M. tuberculosis and from immune-mediated mechanisms. The recognition of cutaneous TB is important, as the diagnosis is frequently overlooked resulting in delayed treatment.
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Affiliation(s)
- J E Lai-Cheong
- Department of Dermatology, University Hospital Lewisham, London, UK.
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Lavilla MJ, Hurtado A, Lezcano MA, Querol I. Lesión crónica en pabellón auricular de 30 años de evolución. Enferm Infecc Microbiol Clin 2006; 24:657-8. [PMID: 17194392 DOI: 10.1157/13095378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- María J Lavilla
- Servicios de Microbiología y Parasitología, Hospital Universitario Miguel Servet, Zaragoza, España
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Hay RJ. Cutaneous infection with Mycobacterium tuberculosis: how has this altered with the changing epidemiology of tuberculosis? editorial review. Curr Opin Infect Dis 2005; 18:93-5. [PMID: 15735409 DOI: 10.1097/01.qco.0000160894.89739.9c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hamada M, Urabe K, Moroi Y, Miyazaki M, Furue M. Epidemiology of cutaneous tuberculosis in Japan: a retrospective study from 1906 to 2002. Int J Dermatol 2005; 43:727-31. [PMID: 15485528 DOI: 10.1111/j.1365-4632.2004.02238.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Interest in tuberculosis has recently been revived, especially in association with the onset of acquired immunodeficiency syndrome (AIDS). In Japan, the incidence of tuberculosis has declined since the 1950s, but has shown a tendency to increase in the past 10 years. METHODS To determine the patterns of prevalence of cutaneous tuberculosis in Japan, data for cutaneous tuberculosis cases recorded between 1906 and 2002 were obtained from the dermatologic clinic of Kyushu University Hospital. The population of tuberculosis-infected patients was stratified into groups encompassing 10-year periods. Each patient group was then classified as having true tuberculosis or tuberculid, as well as being classified by gender. The total number of patients with cutaneous tuberculosis analyzed was 1324. RESULTS The incidence of cutaneous tuberculosis, both true tuberculosis and tuberculid, decreased between 1906 and 1935, increased between 1936 and 1955, and decreased again from 1955. The incidence of true tuberculosis was higher than that of tuberculid between 1906 and 1925. The incidence rates of true tuberculosis and tuberculid were equal from 1926 to 1945, and since 1946 the incidence of tuberculid has been higher than that of true tuberculosis. The incidence of tuberculid decreased between 1986 and 1995, but showed a dramatic increase between 1996 and 2000. The frequency of cutaneous tuberculosis was highest in the 10-49 year age group before 1980, but since 1981 has been highest in groups over 40 years of age. CONCLUSIONS The incidence of cutaneous tuberculosis in Japan is decreasing and shows a shift towards older generations. However, there is an increase in the incidence of tuberculid, especially in elderly female patients.
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Affiliation(s)
- Manabu Hamada
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Moergel M, Walter C, Coerdt W, Reichert TE, Kunkel M. [Chronic cutaneous infiltration with abscess and fistula formation. A type of clinical course in atypical mycobacteriosis]. ACTA ACUST UNITED AC 2004; 8:311-5. [PMID: 15480871 DOI: 10.1007/s10006-004-0562-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cutaneous lesions of atypical mycobacteriosis are very rare in Western Europe. Both the slow disease progression and the rather unspecific clinical appearance of the chronic infiltration render cutaneous mycobacteriosis a diagnostic challenge. In this communication, we present an uncommon, biphasic course of a cutaneous atypical mycobacteriosis. CASE REPORT A 3-year-old child was referred to our institution due to submandibular cutaneous infiltration together with subcutaneous abscess formation. There was no carious lesion or other odontogenic potential source of infection. First-line therapy was incision of the abscess and local curettage to obtain a specimen for histologic and microbiologic evaluation, which revealed atypical mycobacteria. In spite of local curettage, only partial remission of the cutaneous infiltration was achieved. When the child was readmitted 9 months later, the lesion had progressed to a scrofulosis-like appearance even though specific antibiotic treatment had been administered. Complete surgical excision of the affected skin and extirpation of the respective lymph node and fistula was performed as second-line therapy. Complete remission was achieved without further adjuvant treatment. DISCUSSION Our case demonstrates the problems that may arise with this rare type of mycobacterial infection. In all probability, scratch artifacts due to atopic dermatitis provided the source/entry of the infection in this specific case. Both histopathologic findings and clinical appearance were suggestive of classic cutaneous tuberculosis (tuberculosis cutis colliquativa), although it was in fact an atypical mycobacteriosis. Furthermore, obstinate persistence after minor surgical intervention and even after specific (triple) antibiotic treatment illustrates the difficulties of limited, minimally invasive treatment.
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Affiliation(s)
- M Moergel
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Johannes-Gutenberg-Universität Mainz
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Affiliation(s)
- A Zahaf
- Service de Dermatologie, CHU Hédi Chaker, Sfax, Tunisia.
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