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Araki K, Inamine I, Aoki T, Magota M. Papulonecrotic tuberculid caused by Bacille Calmette-Guerin vaccination requiring no antitubercular agents. IDCases 2020; 23:e01021. [PMID: 33364167 PMCID: PMC7750551 DOI: 10.1016/j.idcr.2020.e01021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/04/2022] Open
Abstract
This paper describes a case of papulonecrotic tuberculid after Bacille Calmette-Guerin (BCG) vaccination. A 6-month-old boy was seen in our emergency room with a fever and erythematous papular. He received BCG vaccination at the age of 5 months and there were no systemic problems after the vaccination. There were no abnormal physical findings except for skin lesions and fever. Histopathologically, the lesion was associated with pyogenic granulomatous inflammation and fibrosis, with multiple instances of vascularization and infiltration of various inflammatory cells. Acid-fast stain, culture,and polymerase chain reaction for tuberculous bacillus DNA of the papulonecrotic skin lesions were negative. He was diagnosed papulonecrotic tuberculid caused by BCG vaccination. The fever lasted 10 days, and all lesions healed spontaneously in 2 months. Papulonecrotic tuberculid is a vasculitis caused by an allergic reaction to an internal focus of Mycobacterium tuberculosis or its metabolites. The appearance of an unexplained skin rash may cause parental anxiety, nevertheless the disease may require no treatment unless the patient is immunocompromised. It is necessary to improve awareness regarding the disease as a side effect of BCG vaccination.
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Affiliation(s)
- Kotaro Araki
- Department of Pediatrics, Okinawa Prefectural Yaeyama Hospital, Okinawa, Japan
| | - Itsuki Inamine
- Department of Pediatrics, Okinawa Prefectural Yaeyama Hospital, Okinawa, Japan
| | - Takeo Aoki
- Department of Dermatology, Okinawa Prefectural Yaeyama Hospital, Okinawa, Japan
| | - Miyuki Magota
- Department of Pediatrics, Okinawa Prefectural Yaeyama Hospital, Okinawa, Japan
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Yamada H, Ohta H, Hasegawa S, Azuma Y, Hasegawa M, Kadoya R, Ohbuchi N, Ohnishi Y, Okada S, Hoshide M, Ohga S. Two infants with tuberculid associated with Kawasaki disease. Hum Vaccin Immunother 2016; 12:2772-2776. [PMID: 27435523 PMCID: PMC5137533 DOI: 10.1080/21645515.2016.1208329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Bacille de Calmette et Guerin (BCG) is the only licensed tuberculosis vaccine to prevent severe tuberculosis. The adverse events of BCG vaccination, including local reactions, lymphadenitis, osteomyelitis, tuberculid, and disseminated infection, have been reported. Two infants presented erythema at the inoculation site of BCG after the resolution of Kawasaki disease (KD). They received BCG vaccination 1 week and 6 weeks before the KD onset, respectively. Intravenous immunoglobulin improved the KD activity, however the skin rash of BCG inoculation site extended to the face and extremities days 24 and 10 after the KD onset, respectively. Both bacteriological study and interferon-γ release assay were negative for Mycobacterium tuberculosis infection. These patients were diagnosed as having tuberculid after KD. The skin lesions gradually disappeared without antibiotic therapy over 2 months. The development of tuberculid in these patients might be associated with the remnant immune activation of KD.
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Affiliation(s)
- Hiroko Yamada
- a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Haruka Ohta
- a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Shunji Hasegawa
- a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Yoshihiro Azuma
- a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Masanari Hasegawa
- b Division of Pediatrics , Yamaguchi Grand Medical Center , Hofu , Japan
| | - Ryo Kadoya
- c Division of Pediatrics , Yamaguchi Red Cross Hospital , Yamaguchi , Japan
| | - Noriko Ohbuchi
- c Division of Pediatrics , Yamaguchi Red Cross Hospital , Yamaguchi , Japan
| | - Yuji Ohnishi
- a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Seigo Okada
- a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Madoka Hoshide
- a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Shouichi Ohga
- a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan
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Cohen PR. Injection Site Lichenoid Dermatitis Following Pneumococcal Vaccination: Report and Review of Cutaneous Conditions Occurring at Vaccination Sites. Dermatol Ther (Heidelb) 2016; 6:287-98. [PMID: 26988991 PMCID: PMC4906099 DOI: 10.1007/s13555-016-0105-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background Cutaneous dermatoses and malignancies have occurred at the sites of vaccines. Purpose To describe a man who developed a lichenoid dermatitis at the pneumococcal vaccine injection site and to review cutaneous dermatoses and malignancies occurring at vaccination sites. Methods PubMed was used to search the following terms, separately and in combination: adverse, condition, cutaneous, dermatosis, dermatitis, injection, PCV13, pneumococcal, pneumonia, prevnar, reaction, skin, site, vaccination, and vaccine. All papers were reviewed, and relevant manuscripts, along with their reference citations, were evaluated. Results Several vaccines—including bacillus Calmette-Guerin, hepatitis B, influenza, leishmaniasis, meningitis, pneumococcal, smallpox, tetanus (alone and in combination with diphtheria, pertussis, polio, Haemophilus influenza type B or plague and yellow fever), and varicella-zoster—have been associated with post-vaccination site reactions. A 70-year-old male developed a lichenoid dermatitis that occurred at the pneumococcal vaccine injection site within 2 weeks after PCV13 vaccination; the erythematous nodule resolved spontaneously within 9 weeks following immunization. Conclusions Dermatoses at the injection sites of vaccines can be granulomatous, immunity-related conditions, infections, lichenoid, neutrophilic, or pseudolymphomatous. Basal cell carcinoma and squamous cell carcinoma are the most common vaccination site-associated malignancies; however, melanoma and sarcomas (dermatofibrosarcoma protuberans, fibrosarcoma, and malignant fibrous histiocytoma) are also smallpox vaccine-related site neoplasms. A cutaneous immunocompromised district that is created by vaccine-induced local immunologic changes is hypothesized to be the pathogenesis of vaccination site reactions.
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Affiliation(s)
- Philip R Cohen
- Department of Dermatology, University of California San Diego, San Diego, CA, USA.
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Tirumalae R, Yeliur IK, Antony M, George G, Kenneth J. Papulonecrotic tuberculid-clinicopathologic and molecular features of 12 Indian patients. Dermatol Pract Concept 2014; 4:17-22. [PMID: 24855568 PMCID: PMC4029248 DOI: 10.5826/dpc.0402a03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/19/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Papulonecrotic tuberculid (PNT) is said to be a hypersensitivity reaction to M. tuberculosis. Some reports indicate that organisms are demonstrable by polymerase chain reaction (PCR). METHODS We describe 12 patients with PNT over 6 years. We reviewed the histopathologic features, clinical data and follow-up. PCR for M. tuberculosis DNA was done in all cases. RESULTS There were 7 men and 5 women. The ages ranged from 3-58 years. Upper limbs were commonly involved (8 cases). All patients had multiple papulonodular lesions, 5 showed ulceration and scarring. Mantoux test was strongly positive in all. Seven patients had systemic tuberculosis. On microscopy, necrosis was seen in 11 cases, varying from minimal to extensive. Epithelioid granulomas were common, except for 1 case with palisading and interstitial patterns. The infiltrate showed mostly lymphocytes, while 3 cases showed eosinophils. Vasculitis was seen in 8 cases. Two cases had dermal mucin, one also with interface dermatitis. This patient had concurrent LE. Mycobacterial DNA was detectable by PCR in 3 cases. Seven patients showed improvement/resolution of lesions on treatment. CONCLUSIONS PNT is a rare disease. A positive PCR reiterates the question whether these are "tuberculids". PNT may be better classified as true cutaneous tuberculosis and patients screened for systemic disease.
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Affiliation(s)
- Rajalakshmi Tirumalae
- Departments of Pathology & Dermatology, St. John's Medical College & Hospital, Bangalore, India
| | - Inchara K Yeliur
- Departments of Pathology & Dermatology, St. John's Medical College & Hospital, Bangalore, India
| | - Meryl Antony
- Departments of Pathology & Dermatology, St. John's Medical College & Hospital, Bangalore, India
| | - Geojith George
- Division of Infectious Diseases, St. John's Research Institute; John Nagar, Bangalore, India
| | - John Kenneth
- Division of Infectious Diseases, St. John's Research Institute; John Nagar, Bangalore, India
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Tempark T, Chatproedprai S, Wananukul S, Noppakun N. Persistent erythematous linear plaque on left clavicular area. Int J Dermatol 2013; 52:1037-9. [PMID: 23962261 DOI: 10.1111/ijd.12082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Therdpong Tempark
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Ilkit M, Durdu M, Karakaş M. Cutaneous id reactions: A comprehensive review of clinical manifestations, epidemiology, etiology, and management. Crit Rev Microbiol 2012; 38:191-202. [DOI: 10.3109/1040841x.2011.645520] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brinca A, Andrade P, Vieira R, Figueiredo A. Papulonecrotic tuberculid: report of a clinical case. Dermatol Reports 2011; 3:e29. [PMID: 25386281 PMCID: PMC4211537 DOI: 10.4081/dr.2011.e29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 11/22/2022] Open
Abstract
Papulonecrotic tuberculid is a rare, chronic, recurrent and symmetric eruption of necrotizing skin papules arising in crops, involving primarily the limbs. It occurs in less than 5% of active tuberculosis. Typically bacilli are not detected in any of the cutaneous lesions. Extracutaneous tuberculosis primary focus is only detected in 30–40% of the cases, being the lymph nodes the most common location. Antituberculosis treatment is rapidly effective and is often the main confirmation of the diagnosis.
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Affiliation(s)
- Ana Brinca
- Dermatology Department, Hospitals of Coimbra University, Portugal
| | - Pedro Andrade
- Dermatology Department, Hospitals of Coimbra University, Portugal
| | - Ricardo Vieira
- Dermatology Department, Hospitals of Coimbra University, Portugal
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Niemeyer-Corbellini JP, Spinatto D, Boechat N, Carvalho AC, Pineiro-Maceira J, Azulay DR. Papulonecrotic tuberculid on the scalp. Int J Dermatol 2009; 47:1028-32. [PMID: 18986349 DOI: 10.1111/j.1365-4632.2008.03754.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Joao Paulo Niemeyer-Corbellini
- Department of Medicine, Clementino Fraga Filho University Hospital/Federal University of Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro, Brazil.
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Ramdial PK, Calonje E, Sydney C, Subrayen S, Meyiwa PS, Aboobaker J. Tuberculids as sentinel lesions of tuberculous epididymo-orchitis. J Cutan Pathol 2007; 34:830-6. [DOI: 10.1111/j.1600-0560.2007.00716.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Miyakura T, Yamamoto T, Tsuboi R. Case of Bowen's disease occurring in an old Bacille Calmette-Guerin vaccination site. J Dermatol 2007; 34:416-7. [PMID: 17535414 DOI: 10.1111/j.1346-8138.2007.00303.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Takada T, Yamashita T, Sato M, Kawakami Y, Tominaga A, Ono I, Jimbow M, Tsutsumi H, Jimbow K. Papulonecrotic tuberculid-like eruptions after Bacille Calmette-Guerin vaccination. J Dermatol 2007; 34:183-8. [PMID: 17291299 DOI: 10.1111/j.1346-8138.2007.00246.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
One of the specific skin lesions occurring after Bacille Calmette-Guerin (BCG) vaccination is generalized tuberculid-like eruptions, which occur rarely, but have a tendency to heal spontaneously. Their pathogenesis and relationship to "true" tuberculids are poorly understood. This report presents a case of a 6-month-old girl who developed generalized papulonecrotic tuberculid-like eruptions after BCG vaccination. The skin lesions healed spontaneously in 3 months. Culture of blood, gastric juice and reverse transcription polymerase chain reaction (RT-PCR) of papulonecrotic skin biopsies were all negative for Mycobacterium tuberculosis. Histopathology of papulonecrotic eruptions revealed marked epidermal necrosis, perivascular lymphocytic infiltrates and epidermotropic infiltration of lymphocytes showing markers of CD3(+) lymphocytes (90-95% of all infiltrating cells), CD4(+) (40-50%), CD8(+) (40-50%), and CD45RO(+) (70%). In contrast, the BCG vaccination site revealed intradermal granuloma with epithelioid cells, occasional giant cells and infiltration of lymphocytes consisting of CD3(+) (60-70%), CD4(+) (40-50%), CD8(+) (30-40%), CD45RO(+) (40%), CD79a(+) (30-40%), and CD20(+) (20-30%). Our patient did not reveal any signs indicative of tuberculosis. Papulonecrotic lesions were therefore called papulonecrotic tuberculid-like eruptions, rather than tuberculids, that occurred after BCG vaccination and appeared to derive from a hypersensitive reaction mediated by immune lymphocytic infiltration.
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Affiliation(s)
- Tomoaki Takada
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Inoue T, Fukumoto T, Ansai S, Kimura T. Erythema induratum of Bazin in an infant after Bacille Calmette-Guerin vaccination. J Dermatol 2006; 33:268-72. [PMID: 16674792 DOI: 10.1111/j.1346-8138.2006.00065.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the first case of erythema induratum of Bazin (EIB) after Bacille Calmette-Guerin (BCG) vaccination in an infant. The patient developed recurrent multiple erythematous and subcutaneous nodules on his legs 2 months after a BCG vaccination. He had no other symptoms or family history of tuberculosis (TB). Histopathological findings revealed a granulomatous lobular panniculitis. EIB often appears as a chronic, nodular eruptions that frequently occur on the lower legs of females with tuberculin hypersensitivity. To date, only a few cases of infants with EIB have been reported. There have been no clinical reports of EIB after BCG vaccination. Our case suggests that Mycobacterium bovis in the BCG vaccination may have caused EIB.
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Affiliation(s)
- Tomoko Inoue
- Sapporo Institute for Dermatopathology, Sapporo, Japan
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13
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Cuchet E, Templier I, Brion JP, Béani JC. BCGite après une revaccination accidentelle par le BCG. Ann Dermatol Venereol 2004; 131:1077-9. [PMID: 15692442 DOI: 10.1016/s0151-9638(04)93844-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We report a cutaneous ulceration which occurred following a BCG revaccination. OBSERVATION A 17 year old man, without previous history, presented a large and slow progressive ulceration of the left deltoid area following a fortuitous BCG revaccination. He did not complain of any other symptom. The swab culture from the exudate isolated Mycobacterium bovis whereas the direct analysis by Ziehl staining was negative. The ulceration healed in four months with local and systemic treatment with isoniazid. DISCUSSION BCG vaccination side effects are largely described and can be either nonspecific, like with all vaccinations, or specific and due to the infection with Mycobacterium bovis. It can behave like an infectious agent or an immunogenic agent. The BCG revaccination complications are much less known because there are only few publications in the literature. In our case, the mechanism may have been infectious or imply immune reaction with Arthus'type-phenomenon and/or a type IV hypersensitivity. CONCLUSION Adverse reactions due to revaccination are rarely described should became less frequent when the BCG revaccination is abandoned following the decision of French regulatory authorities. Nevertheless, such complications can occur by accident, as the case in our patient.
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Affiliation(s)
- E Cuchet
- Département pluridisciplinaire de Médecine, Secteur de Dermatologie, CHU Michallon, 38043 Grenoble
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Wang TC, Tzen CY, Su HY. Erythema induratum associated with tuberculous lymphadenitis: analysis of a case using polymerase chain reactions with different primer pairs to differentiate bacille Calmette-Guérin (BCG) from virulent strains of Mycobacterium tuberculosis complex. J Dermatol 2000; 27:717-23. [PMID: 11138538 DOI: 10.1111/j.1346-8138.2000.tb02265.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We retrospectively analyzed a bacille Calmette-Guérin (BCG) vaccinated female patient who developed erythema induratum in association with tuberculous lymphadenitis. The polymerase chain reaction (PCR) with two pairs of primers was performed. Only one pair was able to detect the myocobacterial DNA from the paraffin-embedded specimen of the erythema induratum (EI) lesion. However, both pairs showed positive results with the tuberculous lymphadenitis specimen. Sequence analysis of the PCR products excluded the possibility of BCG as the potential pathogen. Both lesions responded favorably to antituberculous therapy. Our study attests to the tuberculous nature of EI and demonstrates that BCG vaccination per se does not induce the lesion or interfere with the PCR result. Finally, using at least two pairs of primers targeting different genomic segments and possessing species-identification capability may raise the detection rates and solve some controversies about the nature of tuberculids.
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Affiliation(s)
- T C Wang
- Department of Dermatology and Department of Pathology, Mackay Memorial Hospital, 92, Sec 2, Chun-shan N Rd, Taipei 10449, Taiwan
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Alsina M, Campo P, Toll A, Martinez E, Palou J, Herrero C. Papulonecrotic tuberculide in a human immunodeficiency virus type 1-seropositive patient. Br J Dermatol 2000; 143:232-3. [PMID: 10886189 DOI: 10.1046/j.1365-2133.2000.03644.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jordaan HF, Schneider JW, Schaaf HS, Victor TS, Geiger DH, Van Helden PD, Rossouw DJ. Papulonecrotic tuberculid in children. A report of eight patients. Am J Dermatopathol 1996; 18:172-85. [PMID: 8739993 DOI: 10.1097/00000372-199604000-00011] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Papulonecrotic tuberculid (PNT), a form of cutaneous tuberculosis (TB), is uncommon in children. We identified eight children (six girls and two boys) with PNT. Their ages ranged from 19 to 139 months (median 47.5 months, mean:64.75 months). Skin lesions had been present for 2-24 weeks (median: 4 weeks) before diagnosis. All patients displayed scattered papulo- and/or pustulonecrotic lesions on the limbs, and the ears were involved in six patients. Lesions healed with varioliform scars. Associated pulmonary TB was present in seven patients. Additional clinical findings included fever (n = 4), hepatomegaly (n = 4), lymphadenopathy (n = 3), phlyctenular conjunctivitis (n = 3), and splenomegaly (n = 2). Histology of eight biopsies showed ulceration (n = 6), dermal necrosis (n = 6) (follicle-centered in two), granulomatous inflammation (n = 6) (palisading granuloma-like in three), superficial and deep infiltrate of lymphocytes (n = 7), erythrocyte extravasation (n = 7), and subepidermal edema (n = 3). Vasculitis was not a feature. A Ziehl-Neelsen stain was negative in all. Glycosaminoglycans were not increased. Immunohistochemistry found a predominance of T lymphocytes, macrophages, a few antigen-presenting cells, and no B lymphocytes, consistent with a type IV hypersensitivity reaction. Polymerase chain reaction (PCR) performed on deparaffinized tissue identified M. tuberculosis DNA in one biopsy. All patients received combination anti-TB treatment for 6 months. Six patients were compliant and were followed up for 6-30 months. Skin lesions and pulmonary TB healed in all. PNT in children resembles the adult form, but phlyctenular conjunctivitis and associated TB are more common, scrofuloderma and concomitant erythema induratum of Bazin are unusual, and vasculitis is not found. In cases where M. tuberculosis DNA can be confirmed with PCR, papulonecrotic TB is perhaps the more appropriate nomenclature.
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Affiliation(s)
- H F Jordaan
- Department of Dermatology, Faculty of Medicine, University of Stellenbosch and Tygerberg Hospital, South Africa
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Abstract
BACKGROUND Papulonecrotic tuberculid is a rarely reported cutaneous reaction to the mycobacterium bacillus. It is most often encountered in association with tuberculosis. The clinical and histologic picture of the entity is a distinctive one, but the etiology of the disease process is uncertain. Therapy directed against the causative organism is dramatically successful. METHODS A 35-year-old white man with AIDS was referred to the Dermatology clinic for evaluation of a widespread skin eruption. The skin lesions were biopsied for histopathology and culture. From the cutaneous cultures Mycobacterium avium complex (MAC) organisms were grown. RESULTS We report the first case of papulonecrotic tuberculid manifestation in an AIDS patient with disseminated MAC. Unusual features seen in this case include the predominance of pruritic eschars rather than asymptomatic papules and the confirmation by special stains of mycobacterium organisms within the skin biopsy. Papulonecrotic tuberculid has not been previously associated with either MAC or AIDS. CONCLUSIONS Papulonecrotic tuberculid should be a diagnostic consideration in immunocompromised patients with MAC whose clinical and histologic features are compatible with this rare entity.
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Affiliation(s)
- J T Williams
- Department of Pathology, University of Texas Health Science Center, San Antonio 78284
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Sloan JB, Medenica M. Papulonecrotic tuberculid in a 9-year-old American girl: case report and review of the literature. Pediatr Dermatol 1990; 7:191-5. [PMID: 2247386 DOI: 10.1111/j.1525-1470.1990.tb00280.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Papulonecrotic tuberculid is a rare cutaneous manifestation of tuberculosis that can also be associated with other mycobacteria. Clinically, it is an asymptomatic, recurrent eruption of papules with a necrotic center in a symmetric, acral distribution. Tubercle bacilli are not present in skin biopsies. The eruption resolves promptly with antituberculoid therapy. Few patients with this entity have been reported in the United States over the last 50 years. We report a 9-year-old, otherwise healthy, American girl whose sole initial findings were lesions of papulonecrotic tuberculid secondary to Mycobacterium tuberculosis.
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Affiliation(s)
- J B Sloan
- University of Chicago, Department of Medicine, Illinois
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Shea CR, Imber MJ, Cropley TG, Cosimi AB, Sober AJ. Granulomatous eruption after BCG vaccine immunotherapy for malignant melanoma. J Am Acad Dermatol 1989; 21:1119-22. [PMID: 2681298 DOI: 10.1016/s0190-9622(89)70310-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In a patient receiving intralesional bacille Calmette-Guérin vaccine injections for recurrent cutaneous metastases of malignant melanoma of the right leg, a striking eruption developed on that limb only. The eruption consisted of multiple 1 to 2 mm, reddish brown, flat-topped papules, with confluence into plaques. Histopathologic examination showed multiple tuberculoid granulomas within the papillary and reticular dermis; special stains and cultures were negative for mycobacteria.
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Affiliation(s)
- C R Shea
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston 02114
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Affiliation(s)
- K U Kakakhel
- Department of Dermatology, University of Innsbruck, Austria
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