Form Of Cutaneous Tuberculosis Research Articles

Navigating the complexities: a case report on the varied presentation of lupus vulgaris

A 16-year-old female presented with an asymptomatic lesion in the right axilla, evolving over six months into a scaly, erythematous to brownish-colored plaque with associated axillary lymphadenopathy. Routine investigations revealed mild anemia, elevated erythrocyte sedimentation rate (ESR), and a positive Mantoux test. Histopathological examination confirmed lupus vulgaris, characterized by tuberculoid granulomas within the superficial dermis. Treatment with anti-tubercular therapy led to significant lesion improvement. Lupus vulgaris, a form of cutaneous tuberculosis, presents varied clinical features and poses diagnostic challenges. Early recognition and prompt treatment are essential to prevent morbidity and scarring. This case highlights the importance of considering lupus vulgaris in differential diagnosis of atypical cutaneous lesions, contributing to better disease management and reduced morbidity.

Tuberculosis Verrucosa cutis: A case report

TB verrucosa cutis is an inactive, verruca like plaque. Clinically it has classical description. Initially starts as a tiny symptom free warty papule that eventually headway to become a verrucous plaque with a rambling irregular border. Among the form of cutaneous tuberculosis. We report a case of Tuberculosis Verrucosa Cutis in a 54 year old male with a verrucous plaque with hyperpigmentation over the right great toe confirmed with clinical and histopathological features.

Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

Lupus vulgaris (LV) is a progressive, chronic form of cutaneous tuberculosis (CTB). The head and neck regions are the most commonly affected sites, followed by the arms and legs. Occurring in unusual sites may pose diagnostic difficulties. Herein, we report a case of LV present on the dorsal aspect of the right hand in a twenty-year-old Saudi male. It was misdiagnosed as leishmaniasis as the patient lived in an area in which it was endemic, and was treated accordingly with no benefit. A skin punch biopsy was taken and the diagnosis of LV was confirmed. The lesion responded well to anti-tubercular therapy (ATT), yet healed with atrophic scarring. Although rare, clinicians must be aware of the importance of considering CTB as an important differential, as misdiagnosis or delayed diagnosis of this entity may eventually cause prolonged morbidity.

A rare case of scrofuloderma along with lupus vulgaris.

Cutaneous forms of tuberculosis are rare, comprising about 1-1.5% of all cases, and show a wide range of clinical manifestations. Here we present a case of a patient with left cervical ulcerated lymphadenopathy associated with a violaceous plaque in the area of the manubrium of sternum. We performed a biopsy of the plaque for histopathology, a polymerase chain reaction (PCR) to test for mycobacteria and a smear of the ulcerated lymph node. Histopathology results showed a dermal infiltrate consisting of epithelioid granulomas without necrosis, PCR was negative, and the culture was positive for M. tuberculosis. We made the diagnosis of scrofuloderma associated with lupus vulgaris. The patient was treated with an anti-tuberculous therapy with clinical regression of the lesions. Our case emphasizes the importance of recognizing that tuberculosis can occur as a primary cutaneous pathology, with a challenging diagnosis that requires the correlation of clinical findings with diagnostic testing.Transient acantholytic dermatosis (TAD) is a relatively common entity that has been also noted to occur in patients with cancer. Herein, we describe a case of transient acantholytic dermatosis occurring in a patient with a history of prostate cancer status post radiation, now being treated with combination therapy with pembrolizumab and carboplatin-pemetrexed for advanced lung adenocarcinoma. Our case emphasizes the importance of being cognizant of TAD and its associations, particularly in cancer patients.

Diagnostic Dilemma of Cutaneous Tuberculosis: Opening of the Pandora's Box.

Tuberculosis in all forms, that is, pulmonary (PTB) or extrapulmonary (EPTB), is a universal health problem. Cutaneous tuberculosis (CTb) remains one of the least studied and often under-reported variants of EPTB because of its wide and protean clinical presentation. The diagnosis of CTb remains challenging because of lack of sensitive and specific investigations for its diagnosis. The sensitivity of some of the traditional tests is low because of low concentration of mycobacteria in paucibacillary lesions. Besides it is difficult to distinguish between M. tuberculosis (MTb) and other mycobacterial species in skin biopsies morphologically. Molecular methods may target either MTb DNA or RNA, and serve as promising tools in the diagnosis of various forms of CTb, with high sensitivity and rapidity. This review is focused on diagnostic challenges of CTb and to discuss various methods and newer technologies for diagnosing CTb. This will help the dermatologists and dermatopathologists to elucidate and accurately diagnose CTb from other infectious granulomatous dermatitis for appropriate timely treatment of the patient.

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.

Giant Arcuate Lupus Vulgaris with Rapid Progression: A Case Report

Lupus vulgaris is the commonest form of cutaneous tuberculosis. It is a chronic and slowly progressive disease. It can be transmitted either through hematogenous or lymphatic spread but most commonly through contiguous extension.There are many reports on different form of lupus vulgaris but there are only a few reports on large sized lupus vulgaris. Here, we report a case of 75-year-old man with a giant lupus vulgaris rapidly progressing in just two year's duration. Keywords: cutaneous tuberculosis;lupus vulgaris; Nepal.

Scrofuloderma with disseminated tuberculosis in an Ethiopian child: a case report

BackgroundCutaneous tuberculosis represents only 1–2% of extrapulmonary forms of tuberculosis. Scrofuloderma is an endogenous form of cutaneous tuberculosis and can present as isolated or coexist with pulmonary and disseminated forms of tuberculosis. Pathologically confirmed scrofuloderma coexisting with disseminated tuberculosis with a good treatment response is presented and discussed.Case presentationA 12-year-old African Ethiopian girl presented with bilateral neck swelling with purulent discharge and skin ulceration of 3 months’ duration. Dry cough, low-grade fever, decreased appetite, drenching night sweats, global throbbing headache, and a significant amount of weight loss were also reported. Biopsy of the skin identified scrofuloderma, and Mycobacterium tuberculosis was also identified by Xpert MTB/RIF assay. Cerebrospinal fluid analysis and brain computed tomographic scans showed tuberculous meningitis and tuberculoma. Antituberculosis therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol; prednisolone; pyridoxine; and wound care were provided. The patient was discharged for outpatient directly observed antituberculosis therapy in a nearby health center after acute complications were treated and once the skin lesion had started to dry or heal.ConclusionsCutaneous tuberculosis should be considered in a child presenting with a skin lesion or discharge. Cutaneous tuberculosis cases should be investigated for coexisting pulmonary and extrapulmonary forms of tuberculosis. Histopathologic diagnosis should be considered to rule out other skin pathologies and also to prevent delay in treatment. Better tuberculosis prevention strategies, including vaccination scale-up, are warranted.

Erythema induratum: a rare case with unusual presentation

Tuberculosis, still one of the most common infectious diseases globally, manifests primarily as pulmonary tuberculosis. Extra-pulmonary tuberculosis can occur in other sites including skin. Cutaneous tuberculosis, comprising merely 1-2% of all forms of tuberculosis, has been classified into various morphological variants. One of the morphological variants of cutaneous tuberculosis is erythema induratum, a tuberculid, which is caused by hematogenous spread of tuberculosis, the pathogenesis of which is due to hypersensitive reaction against the mycobacterial antigens. The skin biopsy findings of erythema induratum are characterized by panniculitis with formation of non-caseating epithelioid granulomas with no mycobacteria detected in the lesions, though mycobacterial antigens or DNA could be detected by polymerase chain reaction (PCR). In this context, being presented here is a case of erythema induratum which is rare and unusual in its presentation inasmuch as caseating epithelioid granulomas were seen in the lesional skin biopsy along with detection of acid-fast bacilli. In our study a 57-year-old male presented to the Dermatology OPD with multiple erythematous lesions bilaterally over the groin and thigh regions. Clinically the lesions were considered to be equivocally suggestive of migratory erythema or erythema marginatum. The skin biopsy taken from the lesions revealed multiple epithelioid granulomas in the dermis with central areas of caseation necrosis. Sections stained with Ziehl-Neelsen stain showed the presence of occasional acid-fast bacilli. Erythema induratum, a rare tuberculid form of cutaneous tuberculosis, which is pathogenetically considered to be occurring as a result of hypersensitivity reaction against mycobacterial antigens with characteristic absence of tubercle bacilli. In the case presented here erythema induratum presents in a rare unusual manner as a caseating granulomatous lesion with presence of demonstrable acid-fast bacilli.

Lichen Scrofulosorum in a Patient with Tuberculous Cervical Lymphadenopathy: A case report

Introduction: Cutaneous tuberculosis (CTB) is a rare presentation of extrapulmonary tuberculosis (TB) with various clinical manifestations. Tuberculids, a type of CTB, are probably the result of hyperergic immune reaction induced by Mycobacterium tuberculosis. Lichen scrofulosorum (LS) is a rare tuberculid mostly seen in children and young adults with or without other manifestations of tuberculosis. Case report: We present a 30 year old patient presented with a papular eruption on his trunk and upper extremities. The patient had recently started on a 4 drug-regimen treatment for a diagnosed tuberculous cervical lymphadenitis and he was under investigation for pulmonary TB. Histopathology of the papular lesions showed epithelioid granulomas strongly indicating lichen scrofulosorum. The eruption responded to antitubercular therapy with complete clearance of the lesions. Discussion: The tuberculids are a form of CTB caused by hypersensitivity reactions to Mycobacterium tuberculosis. The diagnosis of LS is problematic and frequently delayed because of its rarity and clinical similarity to many other more common skin conditions.

A pediatric case of disseminated mutilating lupus vulgaris: A disgrace for society

Lupus vulgaris (LV) is a chronic and progressive form of cutaneous tuberculosis. The lesions may sometimes be associated with extensive destruction of tissue resulting in marked disfigurement and morbidity. A high index of suspicion is crucial for early diagnosis and treatment and thereby prevention of cosmetic deformity. Lupus vulgaris presenting as disseminated mutilating lesions in a child is uncommon, especially in today's era. Herein, we report an unusual case of lupus vulgaris with coexistence of multiple ulcerative mutilating lesions over face and classical plaque over distant site (right thigh) in a 9 year old girl.

Coexistence of Two Different Morphological Forms of Cutaneous Tuberculosis: A Report of Two Cases.

Coexistence of Two Different Morphological Forms of Cutaneous Tuberculosis: A Report of Two Cases.

Papulonecrotic tuberculid with positive acid fast bacilli

Introduction Tuberculosis is a common infection in immunosuppressed patients. The causative organism is Mycobacterium tuberculosis. Lungs are the commoner site of infection. Papulonecrotic tuberculid (PNT) is a very rare form of cutaneous tuberculosis. Case report We describe a 24-year-old male with end-stage renal disease who had renal transplant. He was on prednisolone, azathioprine and cyclosporin. Six years after the transplantation, he presented with enlarging, painful, erythematous nodules at the dorsum of his feet over a period of 2 months. The nodules ulcerated, were extremely tender and had purulent discharge. The edges were undermined. Cytology smears from the lesions showed acid fast bacilli. The histopathological examination of the lesion showed features consistent with papulonecrotic tuberculid. He had no evidence of active tuberculosis in the lung or elsewhere. He was treated with the anti-tuberculosis regime together with adjustment of the immune-supressants. The ulcers healed well with no recurrence on follow-up. Discussion Direct proof with presence of AFB in the lesion supports the theory that the organism is responsible for development of PNT and not as previously thought to be due to hypersensitivity reaction to the Mycobacterium antigens or an allergic reaction. Prompt response to anti-tuberculosis treatment is the hallmark of PNT.

Nodulo-ulcerative Tuberculosis of the Glans Penis-A Case Report and a Discussion on Nomenclature of Genital Tuberculosis.

Lupus vulgaris is a chronic paucibacillary form of cutaneous tuberculosis occurring in a person with a moderate to high degree of immunity. It commonly occurs over the buttocks and trunk in India. Involvement of the genitalia is uncommon, and lesions involving the penis, extremely rare with few cases reported worldwide. There also exists a confusion regarding nosology of tuberculosis of the genitalia. A brief discussion and review of literature are being discussed along with the report of a case of genital tuberculosis involving the glans penis.

Co-existence of lupus vulgaris with lichen scrofulosorum – A rare association

Abstract Lichen scrofulosorum was first described by Hebra in 1868. It has been classified as a tuberculid under the paucibacillary form of cutaneous tuberculosis. A high index of suspicion is needed to diagnose the condition as the lesion may be subtle and asymptomatic. As most patients have a focus of tuberculosis, extensive screening needs to be done for proper management. We report two cases of co-existence of lupus vulgaris with lichen scrofulosorum, where any systemic focus of tuberculosis could not be identified, and responded to anti-tubercular therapy.

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 METASTATIC TUBERCULOUS ABCESS IN A PATIENT WITH CERVICO-MEDIASTINAL LYMPHATIC TUBERCULOSIS

Metastatic tuberculous abcess or tuberculous gumma is a rare form of cutaneous tuberculosis resulting from haematogenous spread from a non-cutaneous tuberculous focus. A 26-year old patient of Pakistani origin presented at our clinic with an abcess on his right thigh that had slowly grown over a period of two months to a total size of 30 cm. Based on clinical findings, microbiology, CT thigh and CT chest, our patient was diagnosed with a tuberculous abcess and cervico-mediastinal tuberculous lymphadenitis. Antituberculosis drugs were initiated. Cutaneous tuberculosis should be included in the differential diagnosis of chronic cutaneous abcesses, especially in patients from tuberculosis endemic nations.

Multifocal Childhood Cutaneous Tuberculosis: Report of Two Interesting Cases from Sikkim, India

Cutaneous tuberculosis is an important health problem in developing countries such as India. Poverty, overcrowding, malnutrition, and ignorance are predisposing factors. The commonly seen variants of cutaneous tuberculosis are scrofuloderma, lupus vulgaris, and tuberculosis verrucosa cutis. Malnourished children may present with unusual forms of cutaneous tuberculosis. Herein we report two interesting cases of multifocal cutaneous tuberculosis in malnourished children.

Lupus vulgaris: Difficulties in diagnosis

Lupus vulgaris is one of the most common forms of cutaneous tuberculosis. It presents a diagnostic challenge due to its paucibacillary nature. This is a report of a case of a delayed diagnosis of lupus vulgaris, presenting as perianal and peristomal plaques, followed by a review of the diagnostic tools for lupus vulgaris and their limitations.

Treatment of cutaneous infections caused by Mycobacterium tuberculosis

Tuberculosis is still a very common global problem and it is responsible for more than 4,500 deaths every day. The risk of tubercular infection has been estimated to vary from 1% to 2% in developing countries. In the last years, an increased incidence of tuberculosis has been observed, which in countries with a high socio-economic status may be related to the HIV infection prevalence and population migration. The most frequent form of Mycobacteri um tuberculosis infection is tuberculosis of the respiratory system which in Poland accounts for 91.6% of cases. Extra-pulmonary tuberculosis, which includes cutaneous tuberculosis, is rarely observed and its incidence is about 8.4%. With regard to the immunoreactivity or the PPD test and the presence of bacilli, three forms of cutaneous tuberculosis can be distinguished: anergic, reactive and hyperergic. The World Health Organization recommends isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin as the first-line anti-tuberculosis drugs. This paper is a review of the available present knowledge concerning selected medications, their mechanisms of action and potential adverse effects. Moreover, therapeutic schemes for new tuberculosis patients are also presented.