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Sivakrishna S, Mohan P, Senthamizhselvan K, Srinivas BH, Ramamoorthi S. An Uncommon Cause of Chronic Nonhealing Perianal Ulcer. ACG Case Rep J 2023; 10:e01031. [PMID: 37073377 PMCID: PMC10106231 DOI: 10.14309/crj.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/16/2023] [Indexed: 04/20/2023] Open
Abstract
Chronic or persistent, nonhealing perianal ulcers could be due to an infection, inflammation, or a neoplasm. Perianal ulcer as the initial presentation of tuberculosis is rare. Tuberculosis cutis orificialis is a rare ulcerative form of cutaneous tuberculosis that affects the oral cavity, anal canal, or perianal region. A high index of suspicion for tuberculosis as the cause of persistent perianal ulcer is required for early diagnosis and treatment.
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Affiliation(s)
- Sirasapalli Sivakrishna
- Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pazhanivel Mohan
- Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kuppusamy Senthamizhselvan
- Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Bheemanathi Hanuman Srinivas
- Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Subhashini Ramamoorthi
- Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Corrêa Neto IJF, Siá ON, Lopes EA, Macacari RL, Watté HH, Souza RFL, Rolim AS, Robles L. Perianal tuberculosis: A rare disease of late diagnosis. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractTuberculosis remains a public health problem and its rare extrapulmonary forms persist with late diagnosis, which delays the diagnosis and favors the dissemination of the disease. The perianal manifestation occurs in approximately 0.7% of tuberculosis cases and usually manifests as fistulizing disease, but may also present with ulcerated lesions, with necrotic and quite painful clinical picture. Initial treatment should be carried out aimed at controlling perineal and perianal sepsis, with subsequent establishment of specific drug therapy provided by the Health Ministry.
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Affiliation(s)
- Isaac José Felippe Corrêa Neto
- Coloproctology Service, Hospital Santa Marcelina (HSM), São Paulo, SP, Brazil
- Brazilian Society of Coloproctology (SBCP), São Paulo, SP, Brazil
| | - Otávio Nunes Siá
- Coloproctology Service, Hospital Santa Marcelina (HSM), São Paulo, SP, Brazil
| | | | | | - Hugo Henriques Watté
- Coloproctology Service, Hospital Santa Marcelina (HSM), São Paulo, SP, Brazil
- Brazilian Society of Coloproctology (SBCP), São Paulo, SP, Brazil
| | | | - Alexander Sá Rolim
- Coloproctology Service, Hospital Santa Marcelina (HSM), São Paulo, SP, Brazil
- Brazilian Society of Coloproctology (SBCP), São Paulo, SP, Brazil
| | - Laércio Robles
- Coloproctology Service, Hospital Santa Marcelina (HSM), São Paulo, SP, Brazil
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Kwak R, Kamal K, Charrow A, Khalifian S. Mass migration and climate change: Dermatologic manifestations. Int J Womens Dermatol 2021; 7:98-106. [PMID: 33537399 PMCID: PMC7838242 DOI: 10.1016/j.ijwd.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 12/26/2022] Open
Abstract
Major changes in climate resulting in mass migrations have unique dermatologic implications for global vulnerable populations. Dermatologic manifestations commonly accompany the infectious and communicable diseases that proliferate in the settings of confinement, crowding, and limited sanitation associated with mass migration. Ectoparasitic infestations abound in refugee camps, and poor nutrition, hygiene, and compromised immunity put refugees at an increased risk for more dangerous infectious diseases carried by these ectoparasites. Climate change also profoundly affects the worldwide distribution of various vector-borne illnesses, thereby leading to the emergence of various communicable diseases in previously nonendemic areas. Natural disasters not only disrupt important lifesaving treatments, but also challenge various infectious disease control measures that are critical in preventing rapid transmission of highly infectious diseases. This article reviews the infectious diseases commonly found in these scenarios and provides an in-depth discussion of important implications for the dermatologist.
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Affiliation(s)
- Ruby Kwak
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Saami Khalifian
- Department of Medicine, Division of Dermatology, University of California Los Angeles, Los Angeles, CA, United States
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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
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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.
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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
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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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Mosena G, Della Giustina A, Matos D'Almeida Santos J, Schwartz J, Almeida Victorino J. Perianal tuberculosis in an immunocompetent patient. J Eur Acad Dermatol Venereol 2018; 32:e229-e230. [DOI: 10.1111/jdv.14757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G. Mosena
- Department of Dermatology; Irmandade Santa Casa de Porto Alegre; 295 - Centro Histórico 90020-090 Porto Alegre Brazil
| | - A. Della Giustina
- Private Practice; Rua Sinimbu, 1878 Sala 801 95020-002 Caxias do Sul Brazil
| | - J.C. Matos D'Almeida Santos
- Department of Internal Medicine; Irmandade Santa Casa de Porto Alegre; 295 - Centro Histórico 90020-090 Porto Alegre Brazil
| | - J. Schwartz
- Department of Dermatology; Irmandade Santa Casa de Porto Alegre; 295 - Centro Histórico 90020-090 Porto Alegre Brazil
| | - J. Almeida Victorino
- Department of Internal Medicine; Irmandade Santa Casa de Porto Alegre; 295 - Centro Histórico 90020-090 Porto Alegre Brazil
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Tago S, Hirai Y, Ainoda Y, Fujita T, Takamori M, Kikuchi K. Perianal tuberculosis: A case report and review of the literature. World J Clin Cases 2015; 3:848-852. [PMID: 26380834 PMCID: PMC4568536 DOI: 10.12998/wjcc.v3.i9.848] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 07/06/2015] [Indexed: 02/05/2023] Open
Abstract
Tuberculosis (TB) is still a major health problem worldwide. We present a rare case of an immuno-competent patient with perianal TB. A 38-year-old man visited a clinic with pain, swelling, and redness in the perineum. He had been persistently coughing for the past 6 mo. The abscess had formed a fistula to the perianal region, indicating perianal abscess. Mycobacterium tuberculosis was found in sputum and perianal abscess. Surgical drainage was performed, and oral anti-tuberculous drugs were administered for 6 mo. The patient’s clinical course was favorable. On review of the literature on 58 cases of perianal TB, we found that the duration of persistent perianal lesion was much longer in patients without active pulmonary TB (APTB) than in those with APTB (66.4 mo vs 8.3 mo; confidence interval, 0.0760-0.9620, P = 0.0380). Thus, in cases of non-healing or recurrent perianal lesions, TB should be considered.
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Hernández Z, Almeida P, Borrego L, Hernández J. Infiltrated perianal plaques. Perianal Crohn's disease. Int J Dermatol 2013; 52:23-4. [PMID: 23278605 DOI: 10.1111/j.1365-4632.2012.05540.x] [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: 11/27/2022]
Affiliation(s)
- Zaida Hernández
- Department of Dermatology, Complejo Hospitalario Universitario Insular Materno Infantil, Gran Canaria, Spain.
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Affiliation(s)
- L C M Low
- National Skin Centre, Singapore, Singapore.
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Mehta PK, Raj A, Singh N, Khuller GK. Diagnosis of extrapulmonary tuberculosis by PCR. ACTA ACUST UNITED AC 2012; 66:20-36. [PMID: 22574812 DOI: 10.1111/j.1574-695x.2012.00987.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/24/2012] [Accepted: 05/04/2012] [Indexed: 11/30/2022]
Abstract
During the last two decades, the resurgence of tuberculosis (TB) has been documented in both developed and developing nations, and much of this increase in TB burden coincided with human immunodeficiency virus (HIV) epidemics. Since then, the disease pattern has changed with a higher incidence of extrapulmonary tuberculosis (EPTB) as well as disseminated TB. EPTB cases include TB lymphadenitis, pleural TB, TB meningitis, osteoarticular TB, genitourinary TB, abdominal TB, cutaneous TB, ocular TB, TB pericarditis and breast TB, although any organ can be involved. Diagnosis of EPTB can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens. A negative smear for acid-fast bacilli, lack of granulomas on histopathology and failure to culture Mycobacterium tuberculosis do not exclude the diagnosis of EPTB. Novel diagnostic modalities such as nucleic acid amplification (NAA) can be useful in varied forms of EPTB. This review is primarily focused on the diagnosis of several clinical forms of EPTB by polymerase chain reaction (PCR) using different gene targets.
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Affiliation(s)
- Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, Haryana, India.
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