Common Form Of Cutaneous Tuberculosis Research Articles

Lupus vulgaris on face: a case report

Lupus vulgaris is the most common form of cutaneous tuberculosis in adults. Starts either by re-infection or by lymphatic or hematogenous spread or by direct spread in individuals with moderate immunity and high degree of tuberculin sensitivity. Females affected 2-3 times more, constitute 1-2% of all extra-pulmonary TB. Common sites involved are face and neck. We reported a case lupus vulgaris in a 52 year old female patient.

LUPUS VULGARIS-THE UNSHACKLING OF FENRIR- A CASE SERIES

Background: - Lupus Vulgaris is the most common form of cutaneous tuberculosis and accounts for 75% of the cases of cutaneous tuberculosis and 1-2% of all tuberculosis cases. The paucibacillary nature of the disease in some instances, makes it extremely difcult to diagnose, even when histopathology and amplication techniques like Polymerase chain reaction (PCR) are employed. Dermatologists must also be aware of the protean clinical manifestations of this condition as its often misdiagnosed when the index of suspicion is low. We rep Case Series: - ort a series of ve cases of lupus vulgaris among which three have atypical presentation which mimicked Hansen's disease, Discoid lupus erythematosus, Seborrheic dermatitis. Each case was diagnosed with the aid of clinical, laboratory reports and histopathological examination correlation. Lupus Vulgaris is arguably a great mimic, as it can present in a myriad Discussion And Conclusion: - of forms. Strong clinical suspicion, histopathology and response to anti-tubercular therapy may be needed for diagnosis especially when culture and polymerase chain reaction assays are not available or non-contributory. The association of lupus vulgaris and its various presentations with systemic tuberculosis make it essential to have a clear understanding of this condition and early diagnosis and management is the key to prevent the disguring and destructive nature of this disease.

Case Report: A Case of Tuberculosis with Psoriasiform Lichen Scrofulosorum Exhibiting Koebner’s Phenomenon followed by Scrofuloderma

Lichen scrofulosorum is the most common tuberculid in the Indian population and the second most common form of cutaneous tuberculosis. We discuss an uncommon presentation of lichen scrofulosorum, with psoriasiform morphology and koebnerization at tuberculin test site, associated with cervical lymphadenitis in a 17-year-old girl. Although the cutaneous lesions resolved completely after 3 months of antitubercular treatment (ATT), she developed scrofuloderma in the left cervical region at 4 months. In the absence of rifampicin resistance, ATT was continued for another 6 months, with no further evidence of disease activity. This case represents an infrequent occurrence of lichen scrofulosorum followed by scrofuloderma, which necessitated a prolonged course of first-line ATT.

Scrofuloderma: A Rare Case Report of Sequelae of Intestinal Tuberculosis

Abstract Introduction: Scrofuloderma is caused by Mycobacterium tuberculosis and is the most common form of cutaneous tuberculosis. It remains a significant medical challenge because its clinical manifestations mimic those of various other conditions, making diagnosis difficult. Here, we report a 28-year-old man who had been diagnosed with intestinal tuberculosis but discontinued treatment. Case presentation: He subsequently presented with a 5-month history of multiple non-healing ulcerative lesions on the abdomen with no other significant clinical findings. Ziehl-Neelsen staining of an impression smear taken from the lesions was performed as the preliminary investigation and confirmed the presence of acid-fast bacilli. Histopathologic examination of a skin biopsy specimen, PCR, and the Mantoux test also confirmed the presence of Mycobacterium tuberculosis. The patient began treatment with anti-tubercular drugs and his lesions gradually regressed. Discussion: The most common finding of scrofuloderma is a chronic, painless ulcerative lesion with purulent discharge. Cervical lymph nodes are frequently involved. These clinical features mimic several other bacterial and fungal conditions. However, Ziehl-Neelsen staining of the discharging ulcers can be used as a preliminary test to demonstrate acid fast bacilli in most of the cases. Histopathologic examination of skin biopsy specimen, culture on Lowenstein-Jensen media and PCR can confirm the diagnosis. Conclusion: Although Scrofuloderma is a rare cutaneous manifestation, it is curable with early diagnosis and prompt intervention of antitubercular drugs.

Clinical profile of cutaneous tuberculosis at Nashik

This study was conducted to determine the clinical pattern, nature and prevalence of cutaneous tuberculosis in Nashik, India. We report 52 cases of cutaneous tuberculosis that were diagnosed at our outpatient department from January 2018 to December 2019. All the cases were diagnosed clinically, and biopsies were examined for histopathological evidence. Clinically, 26 (50%) cases of lupus vulgaris, 15 (29%) of scrofuloderma, six (12%) of tuberculosis verrucosa cutis, four (8%) of papulonectrotic tuberculid, and one (2%) of lichen scrofulosorum were observed in our department from 2018 to 2019. All the patients were between 5 and 65 years old. Five patients were children under 10, 29 (56%) were between 10 and 30 years old, 13 (25%) were between 30 and 50 years old, and five (10%) were over 50. There was a male (64%) predominance compared to female patients (37%). Histopathology of all the specimens showed granulomatous changes, in the majority of cases Langhans giant cells. Epithelioid cell infiltration and other inflammatory cells, such as lymphocytes, neutrophils, and eosinophils, were seen in ulcerated lesions. The study had some limitations. The sample size was small and the study was carried out in a rural setting, where agriculture is the main source of income and most of the patients treated are farm laborers. Lupus vulgaris was the most common form of cutaneous tuberculosis in this area. The incidence was higher in working adult males, indicating that trauma may be one of the causes of cutaneous tuberculosis. The high rate of clinical-histological confirmation seen in this study emphasizes the importance of skin biopsy in patients with cutaneous TB.

Lupus Vulgaris of the External Nose in a Paediatric Patient: A Case Report from Muhimbili National Hospital, Tanzania

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients who have been previously sensitized to Mycobacterium tuberculosis.[1] We present a case of a 4-year-old girl who was diagnosed to have lupus vulgaris clinically and was then confirmed histopathologically. On local examination, the patient had irregularly bordered, well demarcated, whitish to reddish lesion on her external nose. The histopathological examination showed many dermal stromal granulomas of epithelioid cells, many multinucleated giant cells of Langhans type. This case report is therefore to emphasize on the importance of early diagnosis of lupus vulgaris of the external nose both clinically and on histopathological basis so as to avoid its destructive consequences which are mainly erosion of the external nose, nasal cavity and the face and in rare occasions, possible development of a carcinoma of squamous cell type.________________________________________________________________________Key words: Lupus vulgaris, external nose, Tanzania

Facial lupus vulgaris neglected for 50 years

Tuberculosis (TB) is still a problem in the developed and underdeveloped countries, and cutaneous TB is a small part of extrapulmonary forms. Lupus vulgaris (LV) is the most common form of cutaneous TB among Western populations. In Morocco, scrofuloderma is the most common form of cutaneous TB followed by LV. LV results both from inoculation and from the endogenous spread through hematogenous or lymphatic route from an underlying infectious focus. We report a case of facial LV with a long delay in diagnosis of 50 years. A 59-year-old man presented with a right cheek slow-growing lesion for 50 years. Skin biopsy showed tuberculoid granulomas without caseous necrosis, and the culture of cutaneous biopsy was negative. The polymerase chain reaction of Mycobacterium complex-specific DNA sequences on a fresh skin biopsy material was positive. The patient was given antituberculous treatment with which lesion improved. The delayed diagnosis of 50 years is atypical, especially that the lesion had a display character. Delayed diagnosis of cutaneous TB will cause a significant increase in morbidity. Early diagnosis and treatment is the key to reduce the morbidity.

A clinico-histopathological study of lupus vulgaris: A 3 year experience at a tertiary care centre.

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

Atypical Presentation of Lupus Vulgaris: A Case Report

Lupus vulgaris is the most common form of cutaneous tuberculosis. It is acquired by inoculation from injury or by hematogenous spread from an infective focus. Clinically, it varies tremendously from erythematous plaque to destructive and perforating lesions. Thus the diagnosis of lupus vulgaris becomes a challenge to clinician at times. Atypical forms can mimic various other dermatological conditions leading to delay in diagnosis and increased morbidity. Here we report a rare presentation of lupus vulgaris which was mimicking mycetoma or osteomyelitis. Strong clinical suspicion, histopathology and response to anti-tubercular treatment led to the diagnosis. In this report, emphasis on the early diagnosis and prompt treatment is made.

Cutaneous tuberculosis of the pinna: a report of two cases

Cutaneous tuberculosis (TB) is less common than other forms of TB but accounts for 1.5% of all cases of extrapulmonary TB. The source of mycobacterial infection and the immune status of the host determine the presentation of any of a wide spectrum of clinical manifestations. Lupus vulgaris (LV) is a post-primary, paucibacillary form of TB caused by hematogeneous, lymphatic, or contiguous spread from elsewhere in the body. We report two recent cases of LV in women presenting with the exclusive involvement of the ear lobe. In Patient 1, clinical presentation appeared as an apparently benign chronic eczematous process. In Patient 2, it appeared as a fulminant ulceronecrotic process. Both women were immunocompetent, and neither had a personal or family history of TB. Both patients were diagnosed with LV and treated with standard antitubercular therapy (ATT). In both patients, mycobacterial culture showed growth of Mycobacterium tuberculosis sensitive to streptomycin, rifampicin, and ethambutol. Lupus vulgaris is the most common form of cutaneous TB. It is important to diagnose LV because it can result in chronic disfigurement and because 10-20% of LV patients have active pulmonary TB or TB of the bones and joints. In addition, longstanding LV is known to lead to the development of squamous cell carcinoma, which can be avoided by early diagnosis and treatment with ATT.

Two Cases of Lupus vulgaris in Childhood and Review of the Clinical Challenges

Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis (TB) in Europe, nevertheless the overall incidence is low. It constitutes about 1.5% of all extra-pulmonary cases worldwide. A slight raise in TB incidence rates among children was recently registered in Germany, which can be explained by the increased immigration. We present 2 cases of immigrated children who were diagnosed with Lupus vulagris, both clinically and histopathologically. Although the symptoms and the duration of the skin lesions were very different, both patients had a non-healing skin ulceration.In our cases cultures of the skin biopsy were positive for Mycobacterium tuberculosis and the lesions showed marked improvement in response to antituberculous treatment. In the first patient, it took 6 years between occurrence of skin lesions and final diagnosis. The second patient had an extracutaneous focus, namely abdominal TB. We report our experience and emphasize on recent advances in the diagnosis and treatment of paediatric skin TB.

Giant lupus vulgaris: A rare presentation

Cutaneous tuberculosis continues to be an important public health problem even with the availability of highly effective anti-tuberculous drugs. It constitutes 0.1% of all cases of extrapulmonary tuberculosis. Lupus vulgaris is the most common form of cutaneous tuberculosis that occurs in previously sensitized individuals with a moderate degree of immunity against tubercle bacilli. The different types of lupus vulgaris include plaque, ulcerative, vegetative, papular and nodular, and tumor forms. A 40-year-old man presented with large multiple plaques over right upper limb, right side of chest and back, and right lower limb for the past 30 years. Histopathology showed numerous noncaseating granulomas with Langhan's type of giant cells. The Mantoux test showed strong positivity and there was excellent response to anti-tuberculous treatment. This case is being reported because of its extreme chronicity of 30 years duration, unusually large size and multiplicity of lesions.

Hypertrophic lupus vulgaris : An unusual presentation

Lupus vulgaris is the most common form of cutaneous tuberculosis occurring in previously sensitized individuals with a high degree of tuberculin sensitivity. Various forms including plaque, ulcerative, hypertrophic, vegetative, papular, and nodular forms have been described. A 30-year-old male patient presented with a very large hypertrophic lupus vulgaris lesion over left side of chest since 22 years. Histopathological examination showed granulomatous infiltration without caseation necrosis. The Mantoux reaction was strongly positive. Hypertrophic lupus vulgaris of such a giant size and that too at an unusual site is extremely rare and hence is being reported.

Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 10-year-old boy who was diagnosed as lupus vulgaris clinically and histopathologically. He had well demarcated, irregularly bordered, pink, infiltrated plaques on his left cheek showing apple-jelly appearance on diascopy. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux reactivity was in normal limits, and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed marked improvement on anti-tuberculosis treatment. We want to emphasize that histopathological examination has diagnostic value in lupus vulgaris in correlation with clinical appearance, when direct analysis or culture is negative.

Lupus vulgaris of the popliteal fossa: A delayed diagnosis

Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis. It commonly presents on the head and neck regions. The diagnosis may be difficult when LV occurs at unexpected regions or in unusual clinical forms. Sometimes special stains for the organism and mycobacterial cultures may be negative. Nevertheless, it is usually possible to reach the correct diagnosis of LV using clinical and histopathological findings. But at times, a therapeutic trial with antitubercular agents may be required.

Incidence of Mycobacterium tuberculosis detection in formalin fixed- paraffin embedded granulomatous dermatoses with Multiplex PCR comparing with fluorescent microscopy and acid fast staining in eastern Iran

Introduction: Distinguishing cutaneous tuberculosis to from other granulomatous dermatoses is usually difficult. We used polymerase chain reaction (PCR) to evaluate the incidence of cutaneous tuberculosis and comparison of PCR with other conventional methods in formalin-fixed, paraffin-embedded tissues (FFPE) having unspecified granulomatous inflammation. Materials and Methods: A total of 30 consecutive specimens which had been collected from 30 different patients and fulfilled the criteria for tissues described above were used in this study. Samples obtained from skin biopsy archived blocks of Pathology Department of Ghaem Hospital-Mashhad, Islamic Republic of Iran from January 2000 to June 2003 . Two different primer pairs of MD1-MD2 and KD1-KD2 targeting the gene of of 162 bp (common to all mycobacteria) and of 123 bp DNA (specific for M. tuberculosis complex) were used in the PCR assays. Results: Of the 30 specimens, 6 were PCR positive for the 123 bp DNA. All of these 6 cases, were PCR positive for 162 bp DNA too. Cutaneous tuberculosis could be diagnosed in these 6 cases (20.0%).). After reviewing their clinical presentation, 5 cases were considered as lupus vulgaris. No cases was positive only for 162 bp gene.. There were 4 and 5 positive specimens in fluorescent and acid fast staining respectively. Conclusion: These results show that in cutaneous tuberculosis with unclassical clinical and histological presentation, PCR provides rapid and sensitive detection of M. tuberculosis DNA in FFPE specimens. In areas like Iran, where prevalence of extrapulmonary tuberculosis is still high, lupus vulgaris is common form of cutaneous tuberculosis and are seen more frequently than atypical mycobacterial infection. Finally, conventional methods of tissue staining have somewhat lower potency from PCR in distinguishing mycobacteria

Lupus vulgaris: report of two cases

Although there has been a steady decline in the incidence of tuberculosis in recent years, it persists in some regions, and where AIDS is especially prevalent, the number of new cases has been increasing. Thus, cutaneous tuberculosis has re-emerged in areas with a high incidence of HIV infection and multidrug-resistant pulmonary tuberculosis. Lupus vulgaris has been and remains the most common form of cutaneous tuberculosis. Cutaneous manifestations of disseminated tuberculosis are unusual, being seen in less than 0.5% of cases. Scrofuloderma, tuberculosis verrucosa cutis and lupus vulgaris comprise most cutaneous tuberculosis cases. Bacillus Calmette-Guerin (BCG) is derived from an attenuated strain of Mycobacterium bovis and is employed beneficially as a relatively safe vaccination in Poland and other countries in which the prevalence of tuberculosis is high. However, BCG vaccination may produce complications, including disseminated BCG and lupus vulgaris, the latter seen in one of our two patients in whom lupus vulgaris at the inoculation site followed a second vaccination with BCG 12 years after the initial one. A similar phenomenon has been described after immunotherapy with BCG vaccination. Re-infection (secondary) inoculation cutaneous tuberculosis may also occur as a result of BCG vaccination, producing either lupus vulgaris or tuberculosis verrucosa cutis, probably depending upon the patient's degree of cell-mediated immunity. However, most lupus vulgaris cases are not associated with vaccination with BCG, as occurred in our first patient. For those who do develop lupus vulgaris, it can be persistent for a long period, in some cases for many decades. In the second patient we describe a lengthy duration and cutaneous reactivation at distant sites after more than 40 years.

Lupus vulgaris: Clinical, histopathologic, and bacteriologic study of 10 cases

Lupus vulgaris (LV) represents the most common form of cutaneous tuberculosis in Europe. However, recent reports from European countries are few and usually limited to isolated cases. We report the clinical, histopathologic, and bacteriologic data in 10 patients with LV. The diagnosis of LV was made according to a combination of clinical, histologic, and bacteriologic criteria. In each case a biopsy specimen was obtained for histopathologic study and mycobacteriologic culture. All but one patient received a 9-month course of combined antituberculous therapy. Five patients had evidence of either previous or simultaneous tuberculous foci other than LV. Mycobacterium tuberculosis was isolated from cutaneous lesions in five cases. The histologic study revealed a variable granulomatous reaction, including tuberculoid granulomas, sarcoidlike granulomas, and a "mixed" granulomatous reaction. Although different mechanisms could be implicated in the development of LV, an association with visceral tuberculosis is not infrequent. Combined antituberculous therapy should be the treatment of choice in these patients.