1
|
Kaul S, Kaur I, Mehta S, Singal A. Cutaneous tuberculosis. Part I: Pathogenesis, classification, and clinical features. J Am Acad Dermatol 2023; 89:1091-1103. [PMID: 35149149 DOI: 10.1016/j.jaad.2021.12.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/23/2022]
Abstract
Tuberculosis is an ancient disease that continues to affect an estimated 10 million people per year and is responsible for 1.4 million deaths per year. Additionally, the HIV epidemic and multidrug resistance present challenges to disease control. Cutaneous tuberculosis is an uncommon, often indolent, manifestation of mycobacterial infection that has a varied presentation. Its diagnosis is challenging, as lesions mimic other, more common conditions and microbiological confirmation is often not possible. Cutaneous tuberculosis can be broadly categorized into multibacillary and paucibacillary forms. Approximately one-third of skin tuberculosis is associated with systemic involvement. By recognizing cutaneous tuberculosis early, dermatologists can play an important role in disease control. The first article in this 2-part continuing medical education series describes the latest epidemiology, microbiology, and pathogenesis of tuberculosis. Furthermore, we review the classification, clinical manifestations, common clinical differentials, and systemic involvement that occur in cutaneous tuberculosis.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
van Heerden JK, Broadhurst AGB, de Jager RS, du Plessis W, Ebrahim N, Mnguni AT, Schietekat D, Meintjes G. Cutaneous tuberculosis: An infrequent manifestation of a common pathogen in South Africa. S Afr J Infect Dis 2023; 38:526. [PMID: 37435117 PMCID: PMC10331026 DOI: 10.4102/sajid.v38i1.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Cutaneous tuberculosis is an infrequent form of extra-pulmonary tuberculosis, even in high-prevalence settings. We present the case of a patient living with advanced HIV who developed extensive cutaneous tuberculosis. The polymorphic skin lesions were the most striking clinical manifestation of underlying disseminated tuberculosis. Contribution This case report highlights an unusual presentation of tuberculosis. Cutaneous tuberculosis has a wide spectrum of clinical presentations and may be under-recognised by clinicians. We recommend early biopsy for microbiological diagnosis.
Collapse
Affiliation(s)
- Jennifer K van Heerden
- Department of Internal Medicine, Khayelitsha District Hospital, Western Cape Department of Health, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alistair G B Broadhurst
- Division of General Internal Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ruan S de Jager
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Wesley du Plessis
- Division of General Internal Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Nabilah Ebrahim
- Division of General Internal Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ayanda T Mnguni
- Department of Internal Medicine, Khayelitsha District Hospital, Western Cape Department of Health, Cape Town, South Africa
| | - Denzil Schietekat
- Department of Internal Medicine, Khayelitsha District Hospital, Western Cape Department of Health, Cape Town, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
4
|
Dhattarwal N, Ramesh V. Tuberculids: A Narrative Review. Indian Dermatol Online J 2023; 14:320-329. [PMID: 37266079 PMCID: PMC10231720 DOI: 10.4103/idoj.idoj_284_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 06/03/2023] Open
Abstract
Tuberculids are a group of dermatoses with tuberculoid histology and the absence of tubercle bacilli. They are considered to be hypersensitivity reactions to circulating Mycobacterium tuberculosis (M. tb) or its antigens in individuals with good immunity. The objective of the review is to provide a detailed literature review of all available articles on tuberculids in the past 10 years and provide an update on epidemiology, etiopathogenetic mechanisms, clinical manifestations, and treatment. A search was performed on PubMed using the keywords lichen scrofulosorum, papulonecrotic tuberculid, erythema induratum, and erythema nodosum tuberculosis for all articles, with no restrictions on age, gender, or nationalities. An update on tuberculids, including some new concepts in pathogenesis, atypical presentations, new investigative modalities, and treatments are reviewed.
Collapse
Affiliation(s)
- Niharika Dhattarwal
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - V. Ramesh
- Department of Dermatology, ESIC Medical College and Hospital, Faridabad, Haryana, India
| |
Collapse
|
5
|
Hock Gin T, Jiu Wen K, Sze Ying F, Muniandy P. Clinical characteristic of cutaneous tuberculosis in a tertiary hospital in East Malaysia between January 2014 and September 2021. J R Coll Physicians Edinb 2022; 52:363-364. [PMID: 36533387 DOI: 10.1177/14782715221133077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Teo Hock Gin
- Dermatology Department, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Kiing Jiu Wen
- Physician and Dermatology Fellow, Dermatology Department, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Foo Sze Ying
- Dermatologist, Adv M Derm (UKM), Dermatology Department, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Pubalan Muniandy
- Medical Office, Dermatology Department, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| |
Collapse
|
6
|
Wright WF, Gildea JH, Baghli S. Bilateral Recurrent Lower-extremity Nodular Lesions. Clin Infect Dis 2021; 70:1254-1257. [PMID: 32123916 DOI: 10.1093/cid/ciz624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- William F Wright
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg
| | - Jacob H Gildea
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg
| | - Salim Baghli
- Division of Hospital Medicine, Department of Medicine, University of Pittsburgh Medical Center Memorial, Memorial, York, Pennsylvania
| |
Collapse
|
7
|
An Q, Zheng S, Gao XH, Zhang L. Extensive perianal ulcer-A case of tuberculosis cutis orificialis. Dermatol Ther 2020; 33:e13698. [PMID: 32458548 DOI: 10.1111/dth.13698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Qian An
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Song Zheng
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Li Zhang
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
8
|
Mann D, Sant'Anna FM, Schmaltz CAS, Rolla V, Freitas DFS, Lyra MR, Sampaio FMS, do Valle ACF, Lourenço MCS, Quintella LP, Teichner TC, Cavalcante SC, Galhardo MCG. Cutaneous tuberculosis in Rio de Janeiro, Brazil: description of a series of 75 cases. Int J Dermatol 2019; 58:1451-1459. [PMID: 31553059 DOI: 10.1111/ijd.14617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/12/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Brazil is one of the highest tuberculosis (TB) burden countries of the world. Cutaneous tuberculosis (CTB) is a rare form of extrapulmonary manifestation of tuberculosis. This study aimed to describe the clinico-evolutive, laboratory and therapeutic aspects of CTB cases among patients from a cohort with TB in Rio de Janeiro, Brazil. METHODS Cases of diagnosed CTB with microbiologic confirmation or clinical response to anti-tuberculous treatment associated with positive smear or histopathological findings between the years 2000 and 2016 were selected. RESULTS Seventy-five patients with CTB were included, most were women (58.7%) with a median age of 42 years. CTB diagnosis was based on culture in only 42.7% of the cases. Scrofuloderma represented 50.7% of the cases, followed by erythema induratum of Bazin (EIB) (18.7%), tuberculous gumma (13.3%), lupus vulgaris (8%), TB verrucosa cutis (4%), orificial TB (2.7%) and associated forms (2.7%). Other TB presentations were pulmonary (22.7%), mammary (6.6%) and osteoarticular (4%). All patients who completed the treatment (97.3%) had their lesions healed. Only two patients (2.6%) needed to change the therapy due to adverse reactions. Fifty percent of EIB patients presented recurrence. CONCLUSIONS These data highlight the diversity of CTB presentations and the importance of the skin to assist in early identification and treatment of TB. More studies are necessary to improve the knowledge on EIB for a better approach towards these patients, mainly in cases of recurrence.
Collapse
Affiliation(s)
- Danielle Mann
- Post Graduation of Clinical Research on Infectious Diseases, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Flavia M Sant'Anna
- Laboratory of Clinical Research in Mycobacteriosis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Carolina A S Schmaltz
- Laboratory of Clinical Research in Mycobacteriosis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valeria Rolla
- Laboratory of Clinical Research in Mycobacteriosis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Dayvison F S Freitas
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marcelo R Lyra
- Laboratory of Clinical Research in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Felipe M S Sampaio
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Antonio C F do Valle
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria C S Lourenço
- Laboratory of Bacteriology and Bioassays, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Leonardo P Quintella
- Anatomical Pathology Service, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Tullia C Teichner
- Anatomical Pathology Service, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Solange C Cavalcante
- Laboratory of Clinical Research in Mycobacteriosis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria C G Galhardo
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Jia JJ, Chen DC, Feng YG. A 9-year massive scrofuloderma of the scalp cured in 3 months. Int J Dermatol 2018; 58:e34-e36. [PMID: 30390310 DOI: 10.1111/ijd.14267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/03/2018] [Accepted: 09/21/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jin-Jing Jia
- Department of Dermatology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Da-Can Chen
- Department of Dermatology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi-Guo Feng
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
10
|
Mann D, Sant'Anna FM, Schmaltz CAS, Freitas DFS, Rolla VC, Cavalcante SC, Gutierrez-Galhardo MC. Cutaneous tuberculosis and HIV infection at a referral centre in Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz 2018; 113:e180184. [PMID: 30066752 PMCID: PMC6057310 DOI: 10.1590/0074-02760180184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/04/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cutaneous tuberculosis (CTB) is a rare extrapulmonary form of tuberculosis (TB). Despite the increase in the number of cases of TB and HIV, few cases of CTB have been reported. OBJECTIVE To describe CTB cases among patients with HIV infection from a cohort with tuberculosis. METHODS We describe a series of 15 CTB and HIV cases, based on secondary data from 2000 to 2016. Diagnosis was based on isolation of Mycobacterium tuberculosis in culture or clinical response to anti-tuberculous treatment associated with positive smear or histopathologic findings from affected skin or an adjacent lymph node. FINDINGS Scrofuloderma was present in 12 (80%) patients and solitary gumma in three (20%) patients. One case of scrofuloderma was associated with papulonecrotic tuberculid. Seven (46.6%) patients had pulmonary TB. Diagnosis was based on culture in nine patients (60%). The median CD4 cell count was 262 cells/µL. All patients were cured at the end of treatment (median time 6 months). Three patients presented with immune reconstitution inflammatory syndrome. CONCLUSIONS In this study, CTB associated with HIV infection presented as localised forms or in association with pulmonary TB. In patients with HIV who have subacute and chronic skin lesions, CTB should be considered in differential diagnosis, which may represent a good opportunity for early diagnosis of active TB.
Collapse
Affiliation(s)
- Danielle Mann
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| | - Flávia Marinho Sant'Anna
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil
| | - Carolina Arana Stanis Schmaltz
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil
| | - Dayvison Francis Saraiva Freitas
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| | - Valeria Cavalcanti Rolla
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil
| | - Solange Cesar Cavalcante
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil
| | - Maria Clara Gutierrez-Galhardo
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
11
|
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.
Collapse
|