Cutaneous Tuberculosis Research Articles

Dermatological Manifestations Due to Mycobacterium Tuberculosis Infection

Cutaneous tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, especially in its human and bovine varieties, either directly or through its antigenic components, and the clinical pictures it gives rise to depend not only on its pathogenicity, but also on the the host's immune response. It is generally accepted that the skin integument is an organ that is not very receptive to Koch's bacillus and that even the latter suffers, when invading it, its virulence is attenuated: the manifestations are less frequent than those observed in other sites, more chronic and with fewer bacilli since the skin is not an ideal environment for this, however, it is not free from presenting affectations that could put the integrity of patients at risk.

Undermined Skin Lesion Emerged as Tubercular Meningitis: A Case Report

case reports; lupus vulgaris; meningitis; skin; tuberculosis.

Erythema Induratum of Bazin: A Rare Finding in an Old Woman with Subcutaneous Nodules in the Lower Limbs

Erythema induratum of Bazin (EIB) is a chronic nodular eruption that frequently occurs on lower legs of young or middle-aged women. The clinical manifestations of EIB revealed various dermatological disorders that can be easily leads to misdiagnosis. We report a case of a 50-year-old woman who initially presented with EIB. The histopathological specimen was collected from her medial aspect of let leg. The epidermis is unremarkable. The dermis shows fibro fatty tissue, skin adnexae and foci of granuloma with Langhans type of giant cells and some lymphocytic infiltration in the deep dermis which was suggestive of erythema induratum. Her lesions responded to antitubercular therapy (ATT). This case study may help extend the therapeutic regimens for cutaneous tuberculosis.
 CBMJ 2023 January: Vol. 12 No. 01 P: 121-123

Cutaneous and Pulmonary Tuberculosis—Diagnostic and Therapeutic Difficulties in a Patient with Autoimmunity

Cutaneous tuberculosis (CTB) is a very rare disease and accounts for only 1-2% of cases of extrapulmonary tuberculosis (EPTB). Due to the variety of its clinical manifestations, the uncharacteristic appearance of its lesions, resembling other dermatoses in the early stages, and the limited experience of clinicians due to the rarity of CTB, diagnosis is very difficult. Particularly noteworthy is the fact that most cases of EPTB, including skin tuberculosis (TB), can be a manifestation of systemic involvement. In this paper, we present a case of an immunocompromised patient who was diagnosed with CTB almost a year after the first dermatological lesions were located on the lower extremities. At the same time, due to respiratory symptoms, a diagnosis of pulmonary TB (PTB) was made, and radiological and microbiological confirmations were obtained.

Overview of pulmonary tuberculosis and extra pulmonary tuberculosis at the Siloam MRCCC Semanggi cancer hospital in 2018-2020

Clinical manifestations and results of investigations using imaging methods for pulmonary and extrapulmonary tuberculosis (TB) are often mistaken for malignancy, so TB is referred to as a "great imitator." This study aims to describe pulmonary TB and extrapulmonary TB patients at the Siloam MRCCC Semanggi Cancer Specialist Hospital in 2018-2020. A retrospective study design was used in the study with a sample of 71 patients according to the inclusion criteria. The research instrument used was the archives of the Anatomical Pathology Laboratory of the Siloam MRCCC Semanggi Cancer Special Hospital in 2018-2020. Pulmonary TB and extrapulmonary TB results were obtained in 2018 14 patients (19.7%), 31 patients (43.6%) in 2019, and 26 patients (36.7%) in 2020. Most TB occurred in the age range of 21-30 years (36.6%) and female sex (67.6%). Based on the location of the lesion, extrapulmonary TB was found in 64 patients (90.1%) and pulmonary TB in 7 patients (9.9%). Clinical diagnosis showed that 12 patients (17%) were suspected of malignancy, and 55 patients (77.4%) were not. After histopathological examination, 43 tuberculous lymphadenites (60.6%), seven bone and joint TB (9.9%), six lung TB (8.5%), four soft tissue TB (5.6%), 4 Genitourinary TB (5.6%), four gastrointestinal & peritoneal TB (5.6%), two cutaneous TB (2.8%), and one central nervous system TB (1.4%). Risk factors play an important role in the occurrence of pulmonary TB and extrapulmonary TB. Histopathological examination is important to exclude the possibility of malignancy in patients with pulmonary TB and extrapulmonary TB so that treatment can be carried out quickly and accurately.

Progress in the use of human pluripotent stem cells for in vitro modeling of leprosy and cutaneous tuberculosis

Compared with mature cells, human pluripotent stem cells (PSCs) have cellular and organ functions closer to those of primary cells. In infectious skin disease research, PSCs provide accurate pathophysiology for exploring the specific cellular and molecular mechanisms of refractory disease. Herein, we review the latest knowledge of human embryo model construction under laboratory conditions, focusing on important mycobacterial diseases, such as leprosy and tuberculosis. Moreover, an analysis of SARS‐CoV‐2 research using human PSCs or organoids shows that human PSCs play an important role in modelling dermatological infectious diseases and their complex mechanisms.

Cutaneous Tuberculosis among Patients Presenting to Dermatology Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Cutaneous tuberculosis is an uncommon form of extrapulmonary tuberculosis. It can present in various morphological presentations leading to a late diagnosis in many cases. It is mainly associated with significant scarring and morbidity. It is classified as paucibacillary or multibacillary depending on the bacillary load. Similarly, it can be acquired through either an endogenous or an exogenous source. The mainstay of treatment is anti-tubercular medications. The objective of the study was to find out the prevalence of cutaneous tuberculosis among patients presenting to the dermatology outpatient department of a tertiary care centre. A descriptive cross-sectional study was done among the patient presenting to the outpatient department of dermatology and venerology in a tertiary care centre where all patients data from medical records were taken from April 2016 to March 2021 after taking ethical approval from the Institutional Review Committee (Reference number: 503/2078/79). Demographic details of the patients including age, sex, site and duration of the lesion were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Among 1,30,924 cases, 40 (0.03%) (0.02-0.04, at 95% Confidence Interval) cutaneous tuberculosis was seen. The prevalence of cutaneous tuberculosis was similar to the studies done in similar settings. cutaneous; extrapulmonary tuberculosis; tuberculid.

Uncommon manifestation of disseminated tuberculosis with metastatic skin abscesses in an immunocompromised adult patient: A case report

Background: Cutaneous lesions account for less than 2% of all extrapulmonary manifestations of tuberculosis (TB). Metastatic tuberculous abscesses (tuberculous gummas), uncommon forms of cutaneous TB, typically result from the bacillus spreading hematogenously from the main site of infection to the subcutaneous tissue when the body's cell mediated immunity is compromised and present with one or more non-tender and fluctuant subcutaneous nodules. Case Presentation: A 51-year-old male presented with dry cough of one month duration associated with loss of appetite, easy fatigability and vomiting of ingested matter. He had left armpit and lower back skin swellings of similar duration. Physical findings were remarkable for whitish coat over the dorsal part of the tongue, crepitation over the lower two-third of bilateral posterior chest, and non-tender fluctuant masses over the left axilla and lower back region. Chest X-ray revealed multiple bilateral air space nodules and abdominopelvic U/S showed numerous hypoechoic splenic lesions. Urine lipoarabinomannan and Xpert MTB/RIF (mycobacterium tuberculosis/rifampicin) assay from the axillary skin abscess were positive for MTB. He was started on anti-tuberculous therapy and showed marked improvement after a month of follow up. Conclusion: It is worth considering the uncommon manifestations of tuberculosis including metastatic skin abscesses in the appropriate clinical context, to avoid misdiagnosis and underreporting in high tuberculosis burden countries. We strongly advise the utilization of Xpert MTB/RIF assay and/or urine lipoarabinomannan for the diagnosis of different forms of tuberculosis including cutaneous TB in HIV positive patients, especially in the absence of sputum for microbiologic tests, like in our patient

Tuberculosis cutis orificialis with perianal involvement.

Tuberculosis cutis orificialis with perianal involvement.

Occurrence of Extensive Scrofuloderma in an Immunocompromised Child: A Rare Case Report

Scrofuloderma also called Tuberculosis colliquativa cutis is one of the variants of cutaneous tuberculosis. It can be a skin manifestation of concealed tuberculosis infection. It is most common in countries under development, such as India. It is possible that the individual suffering from Scrofuloderma may not have underlying tuberculosis however, the patient may have come in contact with a tuberculosis patient in the past and due to his/her immunocompromised state the disease manifests. Here, we describe the case of a four-year-old boy presented to the Outpatient Department (OPD) with all the classical sign and symptoms of tuberculosis as low-grade fever, multiple ulcerated nodules at the site of lymph nodes over the neck, axillae, anterior chest wall and inguinal region with history of rupture and extensive crusting. On the basis of presentation and examination the differential diagnosis was made in which Scrofuloderma was first listed. To confirm the diagnosis all the relevant investigations were advised in which Mantoux test, Erthrocyte Sedimentation Rate (ESR) came positive and chest X-ray revealed old resolved tuberculosis. After correlating, clinical findings and laboratory investigations a confirmed diagnosis of scrofuloderma was made and the patient was treated with standard Anti-Tubecular Treatment (ATT). After the completion of standard prescribed period of treatment and specific puckered healing of the ulcerated lesions again confirmed the diagnosis. The aim of reporting is presentation of lesions as superficial bacterial infection and healed old tuberculosis.

Clinicodemographic and Laboratory Characteristics of Cutaneous Tuberculosis at Tertiary Referral Hospital in West Java, Indonesia

Background: Cutaneous tuberculosis (TB) is a chronic infectious disease affecting the skin caused by Mycobacterium tuberculosis (M. tuberculosis). It constitutes 1–1.5% of extrapulmonary TB, with Indonesia being the third-highest TB burden country worldwide. Cutaneous TB is difficult to diagnose due to its varied presentations. This study aimed to describe the clinicodemographic and laboratory characteristics of cutaneous TB in a tertiary referral hospital in West Java, Indonesia. Methods: This was a descriptive retrospective cross-sectional study. Data were obtained from the medical record of patients with cutaneous TB in the Tropical Dermatology Clinic of Hasan Sadikin Hospital Bandung, West Java, Indonesia from January 2017 to December 2019 using total sampling method. Results: Of the 15 data retrieved, tuberculosis verrucosa cutis (n=5) was the most common type of cutaneous TB. Most of patients were males (n=8), between 15–24 years of age (n=6), were students (n=5), with the highest education level of primary school (n=5). Clinically, most of the cases presented as plaques and ulcers (n=6, respectively), had multiple lesions (n=9), located on lower limb (n=6). Acid-fast staining was negative in 8/8 cases, and culture was negative in 4/4 cases. The DNA of M. tuberculosis was detected in 2/5 polymerase chain reaction tests, while granuloma with caseous necrosis was found in 3/5 histopathological examinations. Conclusion: Patients with cutaneous TB have a variety of characteristics. The results of laboratory examinations are often negative, and diagnosis may depend on clinical morphology. Therefore, clinicians should be familiar with the diverse clinical manifestations of cutaneous TB.

Clinicodemographic and Laboratory Characteristics of Cutaneous Tuberculosis at Tertiary Referral Hospital in West Java, Indonesia

Background: Cutaneous tuberculosis (TB) is a chronic infectious disease affecting the skin caused by Mycobacterium tuberculosis (M. tuberculosis). It constitutes 1–1.5% of extrapulmonary TB, with Indonesia being the third-highest TB burden country worldwide. Cutaneous TB is difficult to diagnose due to its varied presentations. This study aimed to describe the clinicodemographic and laboratory characteristics of cutaneous TB in a tertiary referral hospital in West Java, Indonesia.

Update on scrofuloderma

Tuberculosis is one of the most significant diseases which causes death worldwide. TB infection is assumed to infect the lungs only from a general perspective. In fact, TB infection also causes lesions on the skin. Scrofuloderma, as one of the most common types of cutaneous tuberculosis, often misdiagnosed and managed improperly due to its similarity with abscess. In addition, there were still no national and international guidelines for scrofuloderma. This review to give insights and review about an update in the basic principle of scrofuloderma and management.

167 Unusual case of tuberculous chancre at the exact site of application of the Mantoux test

We report an unusual case of cutaneous tuberculosis that developed at the exact site where a Mantoux test (also known as PPD test) was performed. A 25 year old male patient, recently diagnosed with HIV infection and acquired immunodeficiency syndrome (AIDS), in use of lamivudine, efavirenz and dolutegravir for two months, reported cough, night sweats and weight loss. Mantoux test was performed, ordered by his general practitioner, however, the patient presented an intense inflammatory response at the test site with subsequent ulcer formation within four weeks.

CLINICO-HISTOPATHOLOGICAL CORRELATION OF GRANULOMATOUS LESIONS OF SKIN: A RETROSPECTIVE ANALYSIS OF 111 CASES

Introduction: Granulomatous skin lesions present as wide spectrum of clinical conditions where diagnosis with signicant accuracy is possible only through the histopathological examination of biopsy samples. The study was to a Aims and objective: ssess the frequency of granulomatous skin lesions and their pattern in relation to their clinical ndings and histopathology. The retrospective study was conducted Material & Methods: in the department of pathology of our institute. The data related to the age, gender, clinical presentation, and the biopsy ndings was analyzed. Results: Amongst 111 histologically proven cases of granulomatous lesions, there was male preponderance. The commonest age group involved was between 21-40 years. The common primary clinical types were plaque, nodule, and macule present in 42.34%, 31.53% and 15.31% cases respectively. The most common diagnosis was leprosy (54.05%), followed by tuberculosis (39.63%). Among the leprosy cases, borderline tuberculoid and borderline lepromatous were the most common types. Histologically, all lesions showed epithelioid cell granulomas, the commonest type being tuberculoid granuloma. This study reafrms that histopathology is Conclusions: a fundamental tool to diagnose granulomatous skin diseases. Type of granulomas, their pattern and associated features suggest about the diagnosis. Infective diseases (leprosy and cutaneous tuberculosis) are still the most common granulomatous skin diseases.

Dermoscopy of the Diverse Spectrum of Cutaneous Tuberculosis in the Skin of Color.

Cutaneous tuberculosis is an uncommon form of tuberculosis, accounting for 1%-2% of all forms of extra-pulmonary tuberculosis. Knowledge of the dermoscopic characteristics of different clinical types of cutaneous tuberculosis can help timely diagnosis resulting in better outcomes. To characterize the Dermoscopy findings in different clinical types of cutaneous tuberculosis in dark skin phototypes. All clinically suspected and biopsy confirmed cases of cutaneous tuberculosis seen from July 2019 through December 2021 were retrospectively recruited. Information including age, gender, disease duration, site and morphology of lesions, and presence of concomitant tuberculosis elsewhere was noted. Two investigators retrospectively reviewed the dermoscopic characteristics of these cases. Twenty-two patients comprised of 12 women and 10 men met the inclusion criteria. Lupus vulgaris was the commonest presentation of cutaneous tuberculosis seen in 13 patients. Five had scrofuloderma, 2 had tuberculosis verrucosa cutis and 1 patient each had lichen scrofulosorum and papulo-necrotic tuberculid. Yellow-orange structureless areas (100%), linear/dot vessels (100%), white scales (92.3%), and white structureless areas (84.6%) were the predominant dermoscopy findings in lupus vulgaris. In scrofuloderma, linear vessels and white structureless areas were visible in all cases. Dirty white scales with a papillated surface were characteristically seen in tuberculosis verrucosa cutis, with 1 of the 2 patients each showing vessels and yellow-orange structureless areas. White globules with surrounding erythema were seen in lichen scrofulosorum and yellow-orange structureless areas with keratin plugs in papulo-necrotic tuberculid. A thorough understanding of the characteristic dermoscopy of cutaneous tuberculosis can help suspect the diagnosis early resulting in better management opportunity.

Bacillus Calmette-Guérin-induced lupus vulgaris in a patient with Mendelian susceptibility to mycobacterial disease caused by a novel STAT1 variation.

We reported a case of BCG vaccination-induced lupus vulgaris in an 11-year-old girl with Mendelian susceptibility to mycobacterial disease (MSMD) due to a novel STAT1 gene variation. The dermatologists should suspect MSMD in patients with cutaneous tuberculosis after BCG vaccination. It prevents both the patients and the family members with inborn errors of immunity from receiving inadequate vaccines.

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.

Cutaneous Tuberculosis

Background: Cutaneous tuberculosis (TB) is a rare disease seen by the pediatrician on an outpatient basis. It has a varied presentation and is classified on the basis of the source of infection and host's immune response to mycobacteria. Lupus vulgaris (LV) is a paucibacillary manifestation of cutaneous TB. It can mimic other infectious skin diseases such as TB verrucosa cutis and chromoblastomycosis. Clinical Description: We hereby present a case report of an adolescent female with a serpiginous, nodular, and warty hyperpigmented skin lesion over her buttock. The lesion had started following incidental injury 7 years back as a papule and continued to expand despite multiple medications. Management: A skin biopsy was done which was suggestive of cutaneous TB, but the absence of systemic features confounded the diagnostic type. She was finally diagnosed as having LV after a detailed review with a dermatologist and pathologist. The patient responded well to antitubercular treatment. Conclusion: Although cutaneous tuberculosis is well described, it is often not recognized by the primary care physician. Diagnostic dilemmas may arise due to clinical-histopathological mismatch.

Application of metagenomic next-generation sequencing in cutaneous tuberculosis.

Tuberculous infection in a skin wound is a rare but well-known condition. This study describes a child infected with tuberculosis after being wounded. Because of swelling and pain in his wrist tissue, he was admitted to the Affiliated Hospital of Jining Medical University of Shandong Province on 16 October 2021. His medical history only included a wound. He was discharged after debridement. The laboratory data were normal. Two months after surgery, his wound was still swollen and painful. Secretions from the wound were sent for metagenomic next-generation sequencing (mNGS), which revealed three reads related to the Mycobacterium tuberculosis complex group (MTBC). A diagnosis of cutaneous tuberculosis (TB) was made. The wound disappeared after anti-TB drugs were administered. This case demonstrates that, while TB presenting as a severe cutaneous wound is rare, it should be considered in the clinical diagnosis. Clinicians should also pay attention to extrapulmonary infection with MTBC in patients, particularly in some long-suffering patients, and identify the specific pathogen as soon as possible. mNGS could help to identify pathogens and facilitate early treatment, thereby improving the prognosis.