Manifestation Of Cutaneous Tuberculosis Research Articles

Tuberculosis of Penile ShaftA Rare Clinical Presentation

Tuberculosis (TB) is an opportunistic infection caused by Mycobacterium TB, and it has plagued mankind since ages, posing a major health concern in developing countries. Pulmonary TB is the most common form, but extrapulmonary TB is also not uncommon, with an incidence of 8-14%. Cutaneous manifestations of TB, known as lupus vulgaris, are extremely rare, constituting less than 1% of cases worldwide. Diagnosing a cutaneous lesion of TB poses a challenge for clinicians, as it requires both absolute and relative criteria. In the present case report, the author presents the case of a 15-year-old male from a low socio-economic background who presented with painless oedema over the penis for one and a half months. The patient had a history of dry cough and tested positive for Coronavirus Disease-2019 (COVID-19). Systemic examination was normal, and vital signs were stable. Local examination revealed oedema, redness, and phimosis over the penile shaft, along with non tender ulcerative lesions and deep cracks in the groin crease. A skin biopsy revealed lymphocytic infiltration with Langhanstype giant cells and epithelioid cell granulomas, suggesting TB of the skin overlying the penis. Laboratory investigations revealed a positive Mantoux test and an elevated Erythrocyte Sedimentation Rate (ESR) of 42. The patient was initiated on antitubercular therapy, comprising isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE). After one month of treatment, the oedema subsided, and the penile ulcers and groin skin cracks healed. Penile skin involvement in TB is rare, and the clinical appearance of such involvement may vary.

Turkey ear as a cutaneous manifestation of tuberculosis

Lupus vulgaris is the most common morphological variant of cutaneous tuberculosis. Classical lupus lesions are often seen in the head and neck region. Turkey ear is a clinically descriptive term, previously being used for the earlobe with reddish indurated plaque lesions, which recently can be a sign for lupus vulgaris.

Erythema induratum of Bazin as an indicative manifestation of cavitary tuberculosis in an adolescent: a case report

BackgroundErythema induratum of Bazin (EIB) is a rare cutaneous manifestation of tuberculosis (TB) that frequently occurs in middle-aged women. The clinical manifestations of EIB can mimic various skin diseases, easily leading to misdiagnosis or underdiagnosis. We report a case of a 16-year-old Chinese girl who initially presented with EIB and was subsequently diagnosed with cavitary TB.Case presentationThe patient is a 16-year-old Chinese girl who presented with clusters of erythematous subcutaneous nodules on the posterior part of her right lower leg matching the clinical manifestations of EIB but was otherwise asymptomatic. The patient was subsequently diagnosed with cavitary TB on the basis of a positive result from a T-SPOT.TB test and the observation of cavitary lung lesions in chest computed tomography scanning. A good clinical response was observed in the patient after the initial phase of a standard 6-month antibiotic regimen.ConclusionsAdolescents infected with Mycobacterium tuberculosis frequently present atypical symptoms. Cutaneous manifestations of tuberculosis in adolescents can be considered good clinical indicators to predict the underlying disease. Strong clinical suspicion is required for a prompt diagnosis in adolescents with EIB.

Various presentations of cutaneous tuberculosis at a tertiary care centre: a one year prospective study

<p class="abstract"><strong>Background:</strong> Cutaneous tuberculosis is a rare manifestation of tuberculosis accounting for about 1.5% of all the extra pulmonary manifestations, though the prevalence of pulmonary tuberculosis is high in India. The aim of the study was to prospectively analyze the various clinical presentations of cutaneous TB and their age and sex distribution among the OPD attending patients over a period of one year.</p><p class="abstract"><strong>Methods:</strong> Prospective study, conducted during July 2016 to June 2017. Clinically suspected cases of cutaneous tuberculosis were subjected to lesional biopsy and the results obtained were analyzed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 36 clinically suspected cases, 24 turned out to be cutaneous tuberculosis and apart from these, 5 cases were referred from other departments as cutaneous tuberculosis. The predominant presentation was lupus vulgaris in 12 patients, followed by tuberculous verrucosa cutis in 8 cases, tuberculous ulcers in 3 cases and the remaining 2 cases were erythema induratum of Bazin. Among them, 13 were men accounting to about 52% and 7 were children which accounted for 28% and the remaining 5 were women which added to 20%.</p><p class="abstract"><strong>Conclusions:</strong> Though the cutaneous manifestations of tuberculosis is very rare, the recent years have shown a rising incidence especially among children and therefore requires a high index of suspicion in them since India has very high prevalence of tuberculosis as such.</p>

DISSEMINATED CUTANEOUS TUBERCULOSIS

Cutaneous tuberculosis is a clinically and morphologically heterogeneous group of skin diseases directly or indirectly caused by mycobacteria of the tuberculosis complex, occupying the 5th place among all localizations of extra-pulmonary tuberculosis. Manifestations of cutaneous tuberculosis are extremely diverse and depend on the immune status and ways of penetration of mycobacteria into the skin. Skin involvement can occur as a result of exogenous inoculation, contiguous spread from an adjacent focus, or hematogenous spread from other foci. Family cases of disseminated cutaneous tuberculosis are described. A combination of several clinical forms of cutaneous tuberculosis — scrofuloderma, tuberculosis cutis lichenoides (moniliformis scrophulosorum) and lupus — are observed in a 5 year old child with a family history of tuberculosis. The issues of pathogenesis and advanced methods of diagnosis of cutaneous tuberculosis are also discussed.

Cutaneous Manifestation of Tuberculosis

Cutaneous tuberculosis (CTB) is an uncommon form of extrapulmonary tuberculosis (TB). It is characterized as an invasion of the skin by Mycobacterium tuberculosis and, less commonly, Myco- bacterium bovis and the bacilli Calmette-Guerin vaccine. Cutaneous TB is rare despite the high prevalence of TB worldwide. The highest in- cidence of CTB is in underdeveloped, resource-poor countries. With some exceptions, lupus vulgaris (LV) is the most common form. Cu- taneous TB manifests a wide spectrum of clinical presentations, and current classification systems are based on the route of transmission and the immunologic state of the host. The exogenous (or primary) form of CTB occurs via traumatic direct inoculation of M. tuberculosis into the skin or mucous membranes leading to primary cutaneous TB, TB verrucosa cutis, and rarely LV. The endogenous (or secondary) form of CTB occurs through lymphatic, hematogenous, or contiguous spread of M. tuberculosis to the skin from an internal focus leading to the de- velopment of LV, scrofuloderma, TB cutis orificialis, miliary TB, and metastatic TB abscesses. Tuberculids are another form of CTB resulting from a hypersensitivity reaction to an internal source of M. tuberculosis antigens. Diagnosis can be made based on history, morphologic features, and histopathologic characteristics but can be complicated and substan- tially delayed because of the resemblance to other dermatologic condi- tions. Furthermore, skin biopsy and/or acid-fast bacilli staining and culture may fail to reveal the presence of M. tuberculosis .A s with TB of other organs, treatment of CTB requires a 4-drug chemotherapeutic regimen that usually consists of rifampin, isoniazid, pyrazinamide, and etham- butol for 2 months followed by a 2-drug regimen for 4 months. De- pending on the type of CTB, several years of chemotherapy and/or surgical excision may be needed.

Therapy of cutaneous manifestations of tuberculosis in Saudi Arabia

Therapy of cutaneous manifestations of tuberculosis in Saudi Arabia

An Unusual Presentation of Cutaneous Tuberculosis for Surgeons—Review Of Literature

Tuberculosis is one of the oldest diseases on earth. With rising trends of immunosuppressive states, the extrapulmonary manifestations of tuberculosis have emerged and are flourishing. Most often it is the systemic dissemination of the bacilli from the primary infective foci during the periods of low immunity. Cutaneous manifestation of tuberculosis in the form of injection abscess or traumatic inoculation is well known; however, sporadic occurrence of it in the form of abscess with no underlying lesions is quite rare. This would caution the treating units in the endemic areas about the possibility of tuberculosis as the disease in any inflammatory disorder of skin with acute presentations with no systemic symptoms. Only a high index of suspicion would render an early detection and recovery. Our case is one such incident.

"Turkey Ear" as a cutaneous maniestation of tuberculosis

Lupus vulgaris is the most common morphological variant of cutaneous tuberculosis. Classical lupus lesions are often seen in the head and neck region. Turkey ear is a clinically descriptive term, previously being used for the earlobe with reddish indurated plaque lesions, which recently can be a sign for lupus vulgaris. A 65-year-old man presented with lupus vulgaris of the earlobe. The diagnosis was confirmed by conventional laboratory investigations and the patient showed well response to antituberculous therapy. This is the second reported case of “turkey ear” as a manifestation of cutaneous tuberculosis.

Lupus vulgaris als destruierender Nasen- und Gesichtstumor

Lupus vulgaris is the most frequent manifestation of cutaneous tuberculosis, but in Europe it is limited to isolated cases. Mainly immunocompetent individuals are affected by this result of an endogenous reinfection on a lymphogenous-less frequently hematogenous-pathway. Lupus vulgaris has been observed to develop in more than 50% of all patients who already suffer from other manifestations of tuberculosis. The development of a squamous cell carcinoma in the lupus vulgaris is a rare complication; therefore, lupus vulgaris is deemed a facultative precancerosis.A 68-year-old female Serbo-Croatian patient presented with an extensive ulcerative nose and facial tumor. Her anamnesis included a squamous cell carcinoma of the nose that had been excised alio loco 3 years before. Further examinations revealed enlarged cervical lymphoma on both sides, and pulmonary metastases were also suspected. The tumor biopsy revealed a necrotic, granulomatous inflammation. No acid-fast rods were seen on Ziehl-Neelsen stain. The tuberculous origin of this ulcerative skin tumor-the lupus vulgaris-as an endogenous reinfection of pulmonary tuberculosis manifestation was confirmed by the detection of Mycobacterium tuberculosis DNA in polymerase chain reaction and the growth of Mycobacterium tuberculosis colonies in the bacterial culture (skin biopsy and bronchial secretion). The skin tumor as well as the pulmonary manifestation were successfully treated with combined tuberculostatic therapy and showed a dramatic response within 3 months.

Cutaneous manifestations of tuberculosis

Cutaneous involvement is a rare manifestation of tuberculosis (TB). The correct diagnosis is often significantly delayed because cutaneous TB is not routinely considered in the differential diagnosis or because investigations fail to reveal the presence of Mycobacterium tuberculosis. The clinical features of cutaneous TB are diverse, and result from exogenous and endogenous spread of M. tuberculosis and from immune-mediated mechanisms. The recognition of cutaneous TB is important, as the diagnosis is frequently overlooked resulting in delayed treatment.

Papulonecrotic tuberculide: a forgotten cutaneous manifestation of tuberculosis

A 30-year-old Chinese man presented with a 2-month history of enlarging neck masses and a widespread rash. He had first noticed the swellings 10 years ago when a diagnosis of tuberculosis was made. The lymphadenopathy improved after anti-tuberculous therapy but never completely regressed. Seven years later, a skin eruption developed over his limbs and trunk. He described recurring crops of asymptomatic reddish papules which discharged a yellowish fluid and subsequently healed with scarring and hyperpigmentation. There was no pruritus or tenderness and no pulmonary symptoms. Clinical examination revealed a non-tender, 10 cm, firm and ovoid mass with overlying erythema in the right anterior triangle of his neck (Figure 1) with several smaller lumps on the other side. There was a widespread eruption on his trunk and limbs, sparing the face, palms, sole and scalp (Figure 2). Recent lesions consisted of 1cm erythematous papules with a scaly collarette (Figure 3). Older lesions had left atrophic scarring and hyperpigmentation. A clinical diagnosis of papulonecrotic tuberculide was made. An X-ray of the chest was normal. Serum immunoglobulins (IgG, A and M) were moderately elevated. Erythrocyte sedimentation rate and C-reactive protein level were normal. Syphilis serology was negative. A Heaf test was strongly positive (Figure 4). Fine needle aspirations of the neck mass were negative for microscopic identification of acid-fast bacilli and for malignancy. On the other hand, a lymph node biopsy on the left side revealed fragments of connective tissue showing granulomatous inflammation and non-caseating necrosis. Occasional acid-fast bacilli were seen with a Ziehl-Neelsen stain. Skin biopsies were taken of recent, established and old lesions. The histological features of the established lesion were diagnostic, showing a florid, acute on chronic, perivascular and periappendiceal inflammmatory infiltrate involving both the superficial and deep dermis. There was also evidence of lobular panniculitis with fibrinoid necrosis of medium-sized arterial vessels, venulitis and extensive endothelial cell swelling. Histological features of the other two skin specimens were non-specific. No organisms were identified with special stains. Anti-tuberculous therapy with rifampicin, isoniazid and pyrazinamide was started and 2 weeks after treatment, the patient reported a complete cessation in the development of new skin lesions. His skin remains in remission after 6 weeks of treatment.

Guidelines of care for dermatologic conditions in patients infected with HIV

Guidelines of care for dermatologic conditions in patients infected with HIV

Tuberculin testing in tuberculids.

The cutaneous manifestations of tuberculosis can be grouped into two categories: (1) those in which actively multiplying tubercle bacilli are present in the lesions, and (2) those, the tuberculids, in which tubercle bacilli or their products embolize to the skin from some active, but at times obscure focus of the disease. In tuberculids, the embolized bacilli do not long remain viable, apparently because of the intense tissue reaction elicited by their presence in the skin.1,2Two well-defined types of tuberculids are papulonecrotic tuberculid and erythema induratum. In this report we present evidence that the extreme tuberculin sensitivity which characterizes these tuberculids3can best be demonstrated with old tuberculin (O.T.) rather than with more purified derivatives such as the purified protein derivative (PPD). It is of interest that Darier4in 1896 introduced the concept of tuberculid before knowledge about tuberculin skin testing was developed shortly after the turn

HISTOPATHOLOGY OF VARIOUS TYPES OF CUTANEOUS TUBERCULOSIS

It is important in cases of obscure manifestations of cutaneous tuberculosis to correlate the histologic with the clinical observations in order to determine the type of cutaneous tuberculosis present and, hence, the prognosis and treatment. The classification given in the table is offered as a working basis, although it is recognized that occasionally more than

CUTANEOUS NODULODISCOID TUBERCULOSIS OF ANERGIC TYPE

There are variability and multiformity in the cutaneous manifestations of tuberculosis as there are in syphilis, but to a lesser extent. Tuberculosis has different sites of inoculation about which little is known, but which may occur in the skin, tonsils and lymphatic structures, lungs, intestines, bones and joints. The two cases embodied in this report are considered to be cutaneous tuberculosis of an anergic type related to the tuberculid or sarcoid group. They are of infrequent occurrence. The lesions of the skin are considered probably due to mutation or prebacillary granular, coccoid or filamentous forms in the life cycle of the tubercle bacillus. Whether these forms were developmental or degenerative could not be determined. Attenuated or inert tubercle bacilli of low virulence or toxins liberated by such organisms are also possible causes. The bovine type of this organism was suspected in these cases, though an avian species