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Fu S, Lu H, Song XZ. Multiple lupus vulgaris. J Dermatol 2024. [PMID: 38995202 DOI: 10.1111/1346-8138.17384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Shiqi Fu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Haojie Lu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Hangzhou, China
| | - Xiu-Zu Song
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Hangzhou, China
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2
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Kaul S, Jakhar D, Mehta S, Singal A. Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment. J Am Acad Dermatol 2023; 89:1107-1119. [PMID: 35149148 DOI: 10.1016/j.jaad.2021.12.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
Despite the availability of effective treatment regimens for cutaneous tuberculosis, challenges to disease control result from delayed diagnosis, infection with multidrug-resistant mycobacterial strains, and coinfection with HIV. Delayed diagnosis can be mitigated when dermatologists are sensitized to the clinical signs and symptoms of infection and by the incorporation of appropriate diagnostic tests. All cases of cutaneous tuberculosis should be confirmed with histopathology and culture with or without molecular testing. In each case, a thorough evaluation for systemic involvement is necessary. Mycobacteria may not be isolated from cutaneous tuberculosis lesions and therefore, a trial of antituberculosis treatment may be required to confirm the diagnosis. The second article in this 2-part continuing medical education series describes the sequelae, histopathology, and treatment of tuberculosis.
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Affiliation(s)
- Subuhi Kaul
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois
| | | | - Shilpa Mehta
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois.
| | - Archana Singal
- Department of Dermatology, University College of Medical Sciences & GTB Hospital, Delhi, India
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3
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Behera B, Jain S, Mohapatra L, Masatkar V, Panda S. A Clinico-Histopathological Study of Lupus Vulgaris at a Tertiary Care Centre. Cureus 2023; 15:e42710. [PMID: 37575838 PMCID: PMC10420341 DOI: 10.7759/cureus.42710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/15/2023] Open
Abstract
Background and objectives Lupus vulgaris is a chronic, progressive, paucibacillary form of cutaneous tuberculosis that occurs in persons with moderate to high immunity. Due to its varied clinical presentation, it can masquerade as different dermatological conditions. This study describes the demographic patterns and varieties of clinical manifestations that can be possible in this curable illness. Methods This study was conducted over two years and included 19 patients with histopathologically confirmed lupus vulgaris in Odisha, India. Demographic data, clinical features, and response to treatment are presented. Results Thirteen cases (68.4%) were seen in adults and six (31.6%) in pediatric patients. The lower limbs were the more affected (n=10), followed by the upper limb (6), the face (2), and the chest (1). All but one patient had plaque-type lesions. On histopathology, all showed a tuberculoid granuloma with no demonstration of acid-fast bacilli with Ziehl-Neelsen staining. Conclusion In the present study, the incidence was mostly observed in the young and higher activity age groups (5-40 years). Plaque-type lesions were most commonly encountered. In histopathology, all the cases had tubercular granuloma-type lesions without any incidence of malignant transformations. All the patients responded well to conventional multi-drug anti-tubercular chemotherapeutic regimens.
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Affiliation(s)
- Binodini Behera
- Department of Dermatology, Pandit Raghunath Murmu Medical College, Baripada, IND
| | - Sonal Jain
- Department of Dermatosurgery and Hair Transplantation, CUTIS Hospital, Bengaluru, IND
| | - Liza Mohapatra
- Department of Dermatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | | | - Sibaram Panda
- Department of Dermatology, Pandit Raghunath Murmu Medical College, Baripada, IND
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4
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Tharun Ganapathy C, George NM, Selvamuthukumaran S, Anguraj P, Gilani A. An interesting case report of cutaneous tuberculosis of the foot. Int J Surg Case Rep 2022; 100:107763. [PMID: 36308950 PMCID: PMC9618970 DOI: 10.1016/j.ijscr.2022.107763] [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: 08/05/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction and importance Tuberculosis is an age old disease caused by Mycobacterium tuberculosis which has been a menace to public health and thwarting economic growth. Pulmonary tuberculosis being the most common type, extra pulmonary tuberculosis has a greater association with HIV and multidrug resistant tuberculosis. Cutaneous tuberculosis accounts for 1–1.5 % of extra pulmonary tuberculosis. Case presentation A 32 year old female presented to the outpatient department with a two month history of ulcer over the sole of the foot with multiple discharging sinuses and surrounding induration. Laboratory tests reported elevated total leukocyte counts. Magnetic Resonance Imaging of the foot showed diffuse intermuscular edema with an interconnecting sinus tract draining to the sole of the foot. Regular wound dressings and antibiotics showed no resolution. Patient eventually underwent near complete excision of the ulcer. The biopsy was suggestive of tuberculous etiology. She achieved complete resolution with antituberculous drugs by three months. Clinical discussion Cutaneous tuberculosis is often misdiagnosed as it can masquerade as many other commonly encountered dermatological conditions. Microbiological diagnosis plays a crucial role in the accurate diagnosis of cutaneous tuberculosis. These lesions are highly responsive to antituberculous drugs. Conclusion Cutaneous tuberculosis is a rare disease that should be considered in the differential diagnosis of patients with chronic non-healing wounds that are poorly responsive to conventional treatment methods. Cutaneous tuberculosis is an extremely rare disease often misdiagnosed The diagnosis of true cutaneous tuberculosis is established by Acid Fast Bacilli staining, MGIT \ or CBNAAT \ The lesions of cutaneous tuberculosis are extremely responsive to antitubercular drugs.
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Affiliation(s)
| | - Nidhi Mariam George
- Corresponding author at: SRM Medical College Hospital and Research Centre, Kattankulathur 603203, India.
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5
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“Lichenoid Granulomatous Pattern” in a Case of Lupus Vulgaris. Dermatopathology (Basel) 2022; 9:131-135. [PMID: 35645227 PMCID: PMC9149875 DOI: 10.3390/dermatopathology9020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
Lupus vulgaris is a one of the most common skin infections in the Indian subcontinent. Even today, it often creates a diagnostic dilemma for both clinicians and histopathologists. We describe a case of lupus vulgaris that showed lichenoid granulomatous inflammation in the dermis. This pattern is not uncommon, but is rarely described in the literature as newer modalities currently take precedence in diagnosis. Our aim is to make clinicians and dermatopathologists aware of this pattern of inflammation seen in this common infection.
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6
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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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7
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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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8
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Sirka CS, Rout AN, Kumar P, Purkait S. Lupus vulgaris masquerading as tumorous growth. Indian J Dermatol Venereol Leprol 2021; 87:562-565. [PMID: 33871207 DOI: 10.25259/ijdvl_1008_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Pankaj Kumar
- Department of Surgery AIIMS, Bhubaneswar, Odisha, India
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9
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Asmarani Y, Mulia RC, Adriani A. A large verrucous plaque on the buttocks: a case report of an atypical presentation of tuberculosis verrucosa cutis. Pan Afr Med J 2020; 37:131. [PMID: 33425164 PMCID: PMC7757284 DOI: 10.11604/pamj.2020.37.131.26150] [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: 09/20/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022] Open
Abstract
Although the incidence of cutaneous tuberculosis (TB) has declined among all cases in dermatology outpatient settings, atypical cases are still being reported worldwide. These atypical forms can imitate other conditions hence delaying the diagnosis and increased morbidity. We report a case of an atypical presentation of extensive Tuberculosis Verrucosa Cutis (TVC) on the buttocks presenting as an annular hyperkeratotic plaque with central healing. Suspicious clinical manifestations and histopathological features followed by an excellent response with antituberculosis therapy confirmed the diagnosis of TVC. Recalcitrant chronic lesions even with adequate standard treatment should raise suspicion of cutaneous TB, especially in endemic areas.
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Affiliation(s)
- Yulia Asmarani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Hasanuddin, South Sulawesi, Makassar, Indonesia
| | - Rizki Citra Mulia
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Hasanuddin, South Sulawesi, Makassar, Indonesia
| | - Anni Adriani
- Dr. Wahidin Sudirohusodo Hospital, South Sulawesi, Makassar, Indonesia
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10
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Arora P, Sardana K, Gautam RK, Batrani M. Relevant diagnostic implications of the therapeutic challenge with antitubercular therapy in an unusual case of sarcoidosis mimicking lupus vulgaris. Dermatol Ther 2019; 32:e12968. [PMID: 31099451 DOI: 10.1111/dth.12968] [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: 01/25/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/27/2022]
Abstract
Cutaneous manifestations in sarcoidosis are seen in 25-35% of patients with systemic disease and may be the sole manifestation in few patients. It is known that isolated cutaneous sarcoidosis is a great mimicker and can be easily misdiagnosed as other granulomatous conditions especially lupus vulgaris in regions with high burden of tuberculosis (TB). Here we present a case with cutaneous sarcoidosis who was initially misdiagnosed and treated as bifocal lupus vulgaris with antitubercular therapy (ATT) for 6 months. This nonresponsiveness to therapy prompted us to investigate the patient further for other differentials, failing which a diagnosis of cutaneous sarcoidosis was made and the patient was treated with oral steroids and methotrexate with complete clearance of lesions after 14 weeks of therapy. Our case reemphasizes the value of therapeutic trial of ATT in diagnosis of cutaneous TB and highlights the remarkable clinical mimic of sarcoidosis with lupus vulgaris.
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Affiliation(s)
- Pooja Arora
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Ram Krishan Gautam
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Meenakshi Batrani
- Department of Pathology, Delhi Dermpath Laboratory, Delhi Dermatology Group, New Delhi, India
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11
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Denouement. Pediatr Infect Dis J 2019; 38:e80-e81. [PMID: 30882749 DOI: 10.1097/inf.0000000000002151] [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: 11/26/2022]
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12
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Vulvar Tuberculosis Cutis Orificialis Concomitant to Pulmonary Tuberculosis: A Case Report. Am J Dermatopathol 2018; 40:908-911. [PMID: 29877894 DOI: 10.1097/dad.0000000000001182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Tuberculosis (TB) is a common condition with increasing incidence worldwide. Cutaneous TB represents a small portion of extrapulmonary TB. Health care professionals must be aware of cutaneous forms of TB to avoid delay in diagnosis and treatment. We present a case of a 59-year-old woman with vulvar TB cutis orificialis in association with pulmonary TB without any other involvement of genitourinary system. We discuss epidemiological aspects, classification, treatment, range of histopathological patterns, and use of ancillary techniques for diagnosis.
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13
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Laidler N. Cutaneous infection with paucibacillary Mycobacterium tuberculosis treated successfully with a modified antituberculous drug regimen. BMJ Case Rep 2017; 2017:bcr-2017-221938. [PMID: 29275384 DOI: 10.1136/bcr-2017-221938] [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: 11/03/2022] Open
Abstract
Tuberculosis is a serious infection that is increasing in prevalence, affecting many people worldwide. The diagnosis of cutaneous tuberculosis is challenging and requires the correlation of clinical findings with often inconclusive diagnostic testing. Extrapulmonary tuberculosis comprises approximately 10% of all cases of tuberculosis, and cutaneous tuberculosis makes up only a small proportion of these cases. Discussed here is the case of a 61-year-old immunocompetent female with a large cutaneous lesion on her index finger secondary to Mycobacterium tuberculosis Tissue cultures taken at biopsy were negative; however, empiric antimycobacterial therapy was initiated. The initial regimen was not tolerated, and antituberculous therapy was substituted for moxifloxacin and clarithromycin. The lesion improved significantly with a concurrent improvement in function.
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Affiliation(s)
- Nicholas Laidler
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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14
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Agarwal P, Singh EN, Agarwal US, Meena R, Purohit S, Kumar S. The role of DNA polymerase chain reaction, culture and histopathology in the diagnosis of cutaneous tuberculosis. Int J Dermatol 2017; 56:1119-1124. [DOI: 10.1111/ijd.13708] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/01/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Puneet Agarwal
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Elangbam Nelson Singh
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Uma Shankar Agarwal
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Ramsingh Meena
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Saroj Purohit
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Surendra Kumar
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
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15
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Kumaran MS, Narang T, Jitendriya M, Tirumale R, Manjunath S, Savio J. Cutaneous Squamous Cell Carcinoma in Lupus Vulgaris Caused by Drug Resistant Mycobacterium Tuberculosis. Indian Dermatol Online J 2017; 8:257-260. [PMID: 28761842 PMCID: PMC5518577 DOI: 10.4103/2229-5178.209604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Tuberculosis (TB) is still a major public health problem in the world, with many factors contributing to this burden, including poor living conditions, overcrowding, poverty, malnutrition, illiteracy, and rapid spread of human immunodeficiency virus infection. Cutaneous tuberculosis is a less common form of extrapulmonary tuberculosis, and in this paucibacillary form the diagnosis depends on histopathology, tuberculin positivity, and response to treatment. The diagnosis is even more difficult in cases with drug resistant Mycobacterium tuberculosis due to lack of awareness and lack of facilities to diagnose drug resistant tuberculosis. In this article, we describe an unusual case of multidrug resistant lupus vulgaris (LV), in a 34-year-old male who responded to anti-tubercular treatment (ATT) initially, but developed recurrent disease which failed to respond to standard four-drug ATT; subsequently, tissue culture showed growth of multidrug resistant M. tuberculosis. Subsequently, he also developed cutaneous squamous cell carcinoma. This article aims to exemplify a grave complication that can occur in long-standing case of LV, the limitations faced by clinicians in developing countries where tuberculosis is endemic, and classical methods of proving drug resistance are generally unavailable or fail.
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Affiliation(s)
- Muthu S Kumaran
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhukara Jitendriya
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajalakshmi Tirumale
- Department of Pathology, St John Medical College and Hospital, Bengaluru, Karnataka, India
| | - Suraj Manjunath
- Department of Oncosurgery, St John Medical College and Hospital, Bengaluru, Karnataka, India
| | - Jayanthi Savio
- Department of Microbiology, St John Medical College and Hospital, Bengaluru, Karnataka, India
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16
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De Maio F, Trecarichi EM, Visconti E, Sanguinetti M, Delogu G, Sali M. Understanding cutaneous tuberculosis: two clinical cases. JMM Case Rep 2016; 3:e005070. [PMID: 28348793 PMCID: PMC5343121 DOI: 10.1099/jmmcr.0.005070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/18/2016] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB) is an ancient human disease and remains today one of the most important public health problems and the second most frequent cause of death from an infectious disease worldwide. While pulmonary TB is the most common form, extra-pulmonary TB is on the rise due to the increase in immunosuppressed subjects. Cutaneous TB manifestations are rare forms of extra-pulmonary TB due to systemic dissemination of bacilli or direct inoculation, involving skin or skin-associated tissue, more common in immunocompromised subjects. Some risk factors and the features of the lesion may prompt the suspicion of cutaneous TB, but only microbiological assays can confirm the diagnosis. Our work summarizes cutaneous TB manifestations and differences from other skin mycobacterial infections, also describes two characteristic clinical cases.
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Affiliation(s)
- Flavio De Maio
- Insitute of Microbiology, Università Cattolica del Sacro Cuore , Rome , Italy
| | | | - Elena Visconti
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore , Rome , Italy
| | | | - Giovanni Delogu
- Insitute of Microbiology, Università Cattolica del Sacro Cuore , Rome , Italy
| | - Michela Sali
- Insitute of Microbiology, Università Cattolica del Sacro Cuore , Rome , Italy
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17
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Bahour A, Sobh E, Elsayed S, Amer W. Chronic oozing skin lesions in children: Possible tuberculosis? Two case reports. Int J Mycobacteriol 2016; 5:219-22. [PMID: 27242235 DOI: 10.1016/j.ijmyco.2015.12.005] [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: 11/03/2015] [Revised: 11/29/2015] [Accepted: 12/09/2015] [Indexed: 11/15/2022] Open
Abstract
Cutaneous tuberculosis is frequently misleading and challenging, as it mimics a wide differential diagnosis. Here, we present two pediatric cases with chronic multiple ulcerating nodules. Proper history, physical examination, and histopathological analysis are included in the workup of suspected skin tuberculosis. Diagnosis was confirmed by positive culture for mycobacteria.
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Affiliation(s)
- Amira Bahour
- Pediatric Diseases Department, Abbassia Chest Hospital, Cairo, Egypt
| | - Eman Sobh
- Chest Diseases Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
| | - Sahar Elsayed
- Pathology Department, Abbassia Chest Hospital, Cairo, Egypt
| | - Wegdan Amer
- Pediatric Diseases Department, Abbassia Chest Hospital, Cairo, Egypt
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18
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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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Pai VV, Naveen KN, Athanikar SB, Dinesh US, Divyashree A, Gupta G. A clinico-histopathological study of lupus vulgaris: A 3 year experience at a tertiary care centre. Indian Dermatol Online J 2014; 5:461-5. [PMID: 25396129 PMCID: PMC4228641 DOI: 10.4103/2229-5178.142497] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Lupus vulgaris is the most common form of cutaneous tuberculosis in adults. Lupus vulgaris is caused by hematogenous, lymphatic, or contiguous spread from elsewhere in the body. histologically it is charecterised by typical tubercles with or without caseation, surrounded by epitheloid histiocytes and multinucleate giant cells in the superficial epidermis with prominent peripheral lymphocytes. MATERIALS AND METHOD All cases of clinically and histopathologicaly diagnosed lupus vulgaris over the previous five years were included in the study. RESULTS Fourteen cases of lupus vulgaris cases reported during the study period with eaqual incidence among males and females. DISCUSSION Plaque type of lupus vulgaris was the most common type. Histopathologically tubercular granulomas were seen in all cases as compared to other studies. CONCLUSION Different patterns of lupus vulgaris are reported.
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Affiliation(s)
| | | | - S B Athanikar
- Department of Dermatology, Goa Medical College, Bambolim, India
| | - U S Dinesh
- Department of Pathology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
| | - A Divyashree
- Department of Dermatology, Goa Medical College, Bambolim, India
| | - Gaurang Gupta
- Department of Dermatology, Goa Medical College, Bambolim, India
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20
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Suraprasit P, Silpa-Archa N, Triwongwaranat D. Cutaneous miliary tuberculosis in a chronic kidney disease patient. Case Rep Dermatol 2014; 6:253-7. [PMID: 25493081 PMCID: PMC4255995 DOI: 10.1159/000369156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 79-year-old Thai woman with advanced renal failure, dyslipidemia and anemia of chronic disease was admitted to hospital with prolonged fever, productive cough and multiple discrete small pustules on her face, trunk and extremities. A chest X-ray revealed diffuse miliary infiltration. Mycobacterium tuberculosis complex DNA was detected by polymerase chain reaction in sputum and scrapings of pustules from her skin. Blood culture identified M. tuberculosis complex. Pulmonary and cutaneous miliary tuberculosis was diagnosed. The patient's symptoms improved after 3 weeks of treatment with isoniazid, rifampicin, ethambutol and pyrazinamide. This report details a case of cutaneous miliary tuberculosis in a non-dialysis chronic kidney disease patient.
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Affiliation(s)
- Pudit Suraprasit
- Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narumol Silpa-Archa
- Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Is PET-CT scan an effective tool to differentiate the ascites caused by abdominal malignancy and peritoneal tuberculosis? Clin Res Hepatol Gastroenterol 2014; 38:e41-3. [PMID: 24169367 DOI: 10.1016/j.clinre.2013.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 08/27/2013] [Indexed: 02/04/2023]
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Abstract
Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis that accounts for 1% to 2% of cases. Childhood skin tuberculosis represents 18% to 82% of all cutaneous tuberculosis cases. Scrofuloderma and lupus vulgaris are the two most common clinical forms in children. An increase in the number of tuberculids, especially lichen scrofulosorum, has been observed in the last several years. Cutaneous tuberculosis in children can be severe and have a protracted course. Multiplicity of lesions and multifocal disseminated involvement in scrofuloderma and lupus vulgaris is common. Scrofuloderma progressing to gummatous lesions (scrofulous gumma) is mostly described in children. Morbidities and deformities are more severe in children.
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Affiliation(s)
- Gomathy Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India.
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Sharma C, Shekhar S, Sharma V, Sharma M, Aggarwal T. Paucibacillary tubercular vulval ulcer in a sexually inactive pubertal girl: role of therapeutic trial. J Pediatr Adolesc Gynecol 2012; 25:e123-4. [PMID: 23062448 DOI: 10.1016/j.jpag.2012.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 07/09/2012] [Accepted: 07/10/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Genital ulcers in adolescent girls present a complex diagnostic dilemma. Of all the causes of painful vulval ulcer in a virgin girl, tuberculosis is an extremely rare possibility with no case reported in literature. CASE We are reporting a case of tubercular vulval ulcer in a sexually inactive pubertal girl. She had a close contact with active tuberculosis, positive tuberculin skin test, and chronic granulomatous inflammation on vulval biopsy. Therapeutic trial was offered and on follow up visit after 4 weeks, lesion had completely resolved. SUMMARY AND CONCLUSION Unlike previous case reports that describe tubercular vulval ulcers in sexually active or post menopausal women our patient was sexually inactive. In endemic areas tuberculosis should be considered in differential diagnosis of vulval ulcers irrespective of sexual history of the patient.
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Affiliation(s)
- Chanderdeep Sharma
- Department of Obstetrics and Gynecology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, India.
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Belghith I, Badri T, Zaiem A, Benmously R, Mokhtar I. Scrofuloderme avec hypersensibilité à la rifampicine et au pyrazinamide, traité par quadrithérapie incluant l’ofloxacine. Presse Med 2012; 41:437-9. [DOI: 10.1016/j.lpm.2011.07.016] [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: 05/16/2011] [Accepted: 07/05/2011] [Indexed: 11/29/2022] Open
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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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Banashankari GS, Rudresh HK, Harsha AH, Bharathi R, Kamble P. An unusual presentation of cutaneous tuberculosis for surgeons-review of literature. Indian J Surg 2012; 74:314-7. [PMID: 23904721 DOI: 10.1007/s12262-011-0396-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 12/21/2011] [Indexed: 11/29/2022] Open
Abstract
Tuberculosis is one of the oldest diseases on earth. With rising trends of immunosuppressive states, the extrapulmonary manifestations of tuberculosis have emerged and are flourishing. Most often it is the systemic dissemination of the bacilli from the primary infective foci during the periods of low immunity. Cutaneous manifestation of tuberculosis in the form of injection abscess or traumatic inoculation is well known; however, sporadic occurrence of it in the form of abscess with no underlying lesions is quite rare. This would caution the treating units in the endemic areas about the possibility of tuberculosis as the disease in any inflammatory disorder of skin with acute presentations with no systemic symptoms. Only a high index of suspicion would render an early detection and recovery. Our case is one such incident.
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Affiliation(s)
- G S Banashankari
- Department of Microbiology, M.S.Ramaiah Medical College and Hospital, Bangalore, Karnataka India 560054
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Ramam M, Malhotra A, Tejasvi T, Manchanda Y, Sharma S, Mittal R, Ramesh V. How useful is the Mantoux test in the diagnosis of doubtful cases of cutaneous tuberculosis? Int J Dermatol 2011; 50:1379-1382. [DOI: 10.1111/j.1365-4632.2011.04971.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ramesh V, Sen MK, Nair D, Singla R, Sengupta A. Cutaneous tuberculosis caused by multidrug-resistant tubercle bacilli: report of three cases. Int J Dermatol 2011; 50:300-3. [DOI: 10.1111/j.1365-4632.2010.04714.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Sehgal VN, Sardana K, Sharma S. Inadequacy of clinical and/or laboratory criteria for the diagnosis of lupus vulgaris, re‐infection cutaneous tuberculosis: fallout/implication of 6 weeks of anti‐tubular therapy (ATT) as a precise diagnostic supplement to complete the scheduled regimen. J DERMATOL TREAT 2009; 19:164-7. [DOI: 10.1080/09546630701604049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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De D, Khadwal A, Singhi P, Dogra S, Radotra BD, Kanwar AJ. Chronic nonhealing ulcer on the hand. Clin Exp Dermatol 2009; 34:647-8. [PMID: 19508483 DOI: 10.1111/j.1365-2230.2008.02856.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Grieb S, Korkmaz H, Reuter S, Bruch-Gerharz D, Reifenberger J, Schulte K, Kruse R. Tuberculosis cutis colliquativa. Hautarzt 2009; 60:272-5. [DOI: 10.1007/s00105-009-1739-8] [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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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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Sethuraman G, Ramesh V, Ramam M, Sharma VK. Skin Tuberculosis in Children: Learning from India. Dermatol Clin 2008; 26:285-94, vii. [PMID: 18346559 DOI: 10.1016/j.det.2007.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Gomathy Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi 110029, India.
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Khandpur S, Bansal A, Ramam M, Sharma VK, Das AK, Singh MK, Prasad HK. Verrucous tuberculid mimicking Kyrle disease. Int J Dermatol 2008; 46:1298-301. [PMID: 18173528 DOI: 10.1111/j.1365-4632.2007.03374.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous tuberculosis shows wide clinical variation depending upon the virulence of the organism and host immunity. Tuberculids are difficult to diagnose since the organism often cannot be identified or isolated by microscopy, culture or polymerase chain reaction. The diagnosis rests primarily on the identification of a tuberculous focus elsewhere in the body and response to antitubercular therapy. We present the clinicopathological features of an unusual tuberculid in a 30-year-old man, remarkably mimicking Kyrle's disease. He presented with multiple, symmetrically distributed follicular and perifollicular verrucous papules, nodules and plaques on the face, earlobes and extremities since 4 years. Histopathology revealed parakeratotic follicular plug invaginating into the dermis with multiple caseating epithelioid cell granulomas. PCR for M. tuberculosis was negative. The identification of associated axillary tubercular lymphadenitis, strongly positive Mantoux reaction, tuberculoid granulomas on histopathology and complete resolution of the lesions with antitubercular therapy helped in making the diagnosis. We propose the term "verrucous tuberculid" for this entity.
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Affiliation(s)
- Sujay Khandpur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
Three patients with sporotrichoid cutaneous tuberculosis have been described. Two were children of either sex with lesions of lupus vulgaris along the lower limb and one woman had scrofuloderma along the left arm. Culture for Mycobacteria being negative, the diagnosis was based on the clinical picture, positive tuberculin test, granulomatous dermatitis on histopathology and regression with anti-tubercular DOTS therapy. Sporotrichoid presentation of scrofuloderma appeared to simulate sporotrichosis more than sporotrichoid lupus vulgaris. As seen from other reports and the present one, children and those just past adolescence have often been affected. Since sporotrichoid pattern is known to be usually associated with the less pathogenic atypical or non-tuberculous mycobacteria, it is speculated that the good lymphatic drainage and proneness to trauma that go with the high physical activity in these age groups may rarely result in this clinical presentation of cutaneous tuberculosis.
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Affiliation(s)
- V Ramesh
- Department of Dermatology and STD, Safdarjang Hospital and V.M.Medical College, New Delhi, India.
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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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Abstract
Cutaneous tuberculosis continues to be one of the most elusive and more difficult diagnoses to make for dermatologists practicing in developing countries. Not only because they have to consider a wider differential diagnosis (leishmaniasis, leprosy, actinomycosis, deep fungal infections, etc) but also because of the difficulty in obtaining a microbiological confirmation. Despite all the advances in microbiology, including sophisticated techniques such as polymerase chain reaction, the sensitivity of new methods are no better than the gold standard, that is, the isolation of Mycobacterium tuberculosum in culture. Even now, in the 21st century, we rely on methods as old as the intradermal reaction purified protein derivative (PPD) standard test and therapeutic trials, as diagnostic tools. In this situation, it is important to recognize the many clinical faces of cutaneous tuberculosis to prevent missed or delayed diagnoses.
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Affiliation(s)
- Francisco G Bravo
- Instituto de Medicina Tropical Alexander von Humboldt, Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Hospital Nacional Cayetano Heredia, Lima 31, Peru.
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