A case of miliary tuberculosis with cutaneous lesion

Abstract

Miliary tuberculosis associated with cutaneous lesion has been rarely reported. We report a case of miliary tuberculosis in whom the cutaneous lesion was confirmed as tuberculosis by skin biopsy and bacterial examination. A 46-year-old man was admitted because of cough, fever, sore throat and abnormal shadow on the chest X-ray. Physical examination revealed an emaciated man with two ulcerous lesions overlying yellowed crust on the chest wall and fine crackles on the left side of the lung. Laboratory workup revealed a white blood cell count of 10,000 with 15% lymphocytes and positive CRP. Chest X-ray film showed the infiltration with cavity formation in left upper lung field and nodular dissemination. His tuberculin reaction was negative on admission. Sputum, urine and secrete from cutaneous lesion were positive for the acid-fast bacilli and the culture grew Mycobacterium tuberculosis. Examination of the skin biopsy specimen and bone marrow aspiration showed Langhans giant cells around necrotic lesion; therefore the diagnosis of miliary tuberculosis was made. After an initiation of antituberculosis therapy with combined regimen composed of streptomycin (SM), isoniazid (INH), ethambutol (EB) and rifampicin (RFP), this patient improved significantly. Although the case report of miliary tuberculosis tends to increase recently, the report of cutaneous lesion is relatively rare in association with miliary tuberculosis. We discussed this subject with reference to the literatures.