Abstract
Introduction: Extrapulmonary tuberculosis (TB) causes a significant burden of disease worldwide, especially among HIV-infected individuals and those with other immunosuppressive conditions. Cutaneous TB is an important manifestation of extrapulmonary TB but is uncommonly reported in South Africa despite the high burden of HIV and TB co-infection. There is a paucity of published data on clinical presentation and outcome of cutaneous TB in this context. Raising awareness of this condition among clinicians is imperative to improve early diagnosis and optimise treatment outcomes. Patient presentation: In this series, we present three cases of cutaneous TB, two adults and one child, referred to a tertiary hospital from two primary healthcare centres and from a general practitioner. We demonstrate that the clinical presentation is diverse, ranging from papular lesions to abscesses, and that concordant pulmonary TB may be present. Management: In particular, we show the importance of performing diagnostic procedures (e.g. aspiration) in individuals presenting with an abscess that does not respond to broad spectrum antimicrobial treatment, particularly in those with advanced immunosuppression. Outcome and conclusion: The outcome of our three patients was poor, highlighting the need for earlier diagnosis in this WHO Stage 4 condition and intensive management of clinical cases. Keywords: HIV-medicine; Retro-Viral Disease; Mycobacteria; Tuberculosis; Multidrug Resistance; Cutaneous Tuberculosis; Cutaneous Disease; immunocompromised.
Highlights
Extrapulmonary tuberculosis (TB) causes a significant burden of disease worldwide, especially among human immunodeficiency virus (HIV)-infected individuals and those with other immunosuppressive conditions
Cutaneous Mycobacterium tuberculosis (MTB) infection is a form of extrapulmonary tuberculosis (TB) that is uncommon: it accounts for less than 2% of all cases of TB.[1,2]
Pulmonary TB was diagnosed a month later following new onset of cough, loss of weight and a positive Xpert® test on sputum. Both the cutaneous and pulmonary M. tuberculosis strains were susceptible to rifampicin and isoniazid; and the initial treatment was continued following the diagnosis of pulmonary TB
Summary
Cutaneous Mycobacterium tuberculosis (MTB) infection is a form of extrapulmonary tuberculosis (TB) that is uncommon: it accounts for less than 2% of all cases of TB.[1,2] The incidence of cutaneous TB has been reported to decrease in India while increasing incidence was reported in Mexico; there are no time trend data for South Africa available.[2,3,4] The human immunodeficiency virus (HIV) epidemic is an important driver of the occurrence of cutaneous TB; other important factors are the increased rates of TB in specific settings such as healthcare facilities, prisons and homeless shelters; intravenous drug use; diabetes mellitus; and immunosuppressive therapy.[5,6,7,8,9]. Aspirates were taken from the abscess and submitted to the laboratory of medical microbiology, where both the Xpert® Mycobacterium tuberculosis (MTB)/Rif and line probe assay detected M. tuberculosis Based on these two tests, the strain was determined to be resistant to rifampicin and sensitive to isoniazid. A 21-month-old male paediatric patient on ART for eight months presented with multiple abscesses on the forearms and torso His mother was on drug-sensitive TB treatment at the time of the patient’s presentation, and a year prior, the father had died of pulmonary TB. Pulmonary TB was diagnosed a month later following new onset of cough, loss of weight and a positive Xpert® test on sputum Both the cutaneous and pulmonary M. tuberculosis strains were susceptible to rifampicin and isoniazid; and the initial treatment was continued following the diagnosis of pulmonary TB. The patient was lost to follow-up and the outcome is unknown
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