Tuberculoid Granulomas Research Articles

Psoriasiform Type of Lichen Scrofulosorum: Clue to Disseminated Tuberculosis

We present a 16-year-old girl with tuberculosis of the lungs, lymph nodes, and liver, who had extensive inflammatory lesions with pustules, which resembled psoriasis. A skin biopsy showed extensive tuberculoid granulomas surrounding hair follicles, consistent with lichen scrofulosorum. Antitubercular therapy led to resolution of skin lesions. This severe inflammatory type of lichen scrofulosorum is extremely rare.

A Case of Tuberculoid Granuloma Caused by Penetration with a Sea Urchin Spine in the Thumb

A Case of Tuberculoid Granuloma Caused by Penetration with a Sea Urchin Spine in the Thumb

Tuberculoid granulomas in cutaneous sarcoidosis: a study of 49 cases

Tuberculoid granulomas in cutaneous sarcoidosis: a study of 49 cases

Treatment of post‐inflammatory hyperpigmentation using 1064‐nm Q‐switched Nd:YAG laser with low fluence: report of three cases

the inflammatory and ulcerated lesions. MCD is a well suited name for this form. The intertriginous and genital MCD present frequently as an isolated, indurated oedemata associated with rhagades. This infiltrated oedematous MCD would correspond to the presence of the non-caseating tuberculoid granuloma without or minimal vascular injury. For this form, often associated with an anoperineal CD, the term MCD is confused and we suggest to use oedematous cutaneous CD instead.

Variations in Leprosy Manifestations among HIV-Positive Patients, Manaus, Brazil

Variations in Leprosy Manifestations among HIV-Positive Patients, Manaus, Brazil

Non-surgical acute abdomen: intestinal tuberculosis

This was a 21-year-old woman with nonspecific findings in her clinical history, who was operated on for abdominal pain with generalized peritonism, high fever, and severe leukocytosis. No alterations were seen in her thorax. The following was found during the procedure: turbid ascites and generalized peritoneal seeding, particularly in the terminal ileum. A histological examination of biopsy samples revealed tuberculoid granulomas suggestive of miliary seeding. The patient was treated for six months with three tuberculostatic drugs (isoniazid, rifampicin, pyrazinamide), and remains asymptomatic to this day. Diagnosis: intestinal tuberculosis.

Intrapulmonary Delivery of XCL1-Targeting Small Interfering RNA in Mice Chronically Infected withMycobacterium tuberculosis

Mice infected for 60 days with Mycobacterium tuberculosis were treated with aerosolized XCL1-targeting small interfering RNA (siRNA) to induce local and transient suppression of XCL1/lymphotactin (an important chemokine in tuberculoid granuloma formation). The local pulmonary siRNA therapy resulted in a 50% decrease in the total amount of xcl1 gene transcripts at 3 days, and 40 to 50% protein suppression 3 and 5 days after treatment. Reduced XCL1 expression in the lungs was associated with decreased numbers of T lymphocytes, reduction in the IFN-gamma response, disorganized granulomatous lesions, and higher fibrosis when compared with control mice treated with either PBS or nontargeting siRNA. This indicates that a transient but strong modulation of the production of XCL1 in the lungs has a significant effect on the influx of IFN-gamma-secreting T cells, as well as local pathology, but without significantly altering containment of the infection.

Primary tuberculous osteomyelitis of the mandible: a case report

A 10-year-old female child presented with a gradually increasing swelling of 2 months' duration on the left side of her face. The history given by the guardian was not very specific. However, the history revealed possible contact between the child and a tuberculous patient. The initial clinical and radiological evaluation indicated either a chronic residual dentoalveolar abscess, tuberculosis (TB) of the mandible or a malignancy. Routine laboratory investigations were grossly unremarkable with only the erythrocyte sedimentation rate being mildly raised. Further investigations were carried out, including a purified protein derivative test, chest screening, sputum examination, enzyme-linked immunosorbent assay for HIV and abdominal ultrasound, which were all negative. CT of the mandible showed a soft tissue mass in the submandibular region with an osteolytic lesion in the body of the mandible on the left side, and fine needle aspiration cytology (FNAC) showed the presence of a tuberculoid granuloma. FNAC, along with the clinical and radiographic findings and history, led to the diagnosis of primary TB of the mandible. Although FNAC is not as effective as an actual biopsy, it is often adequate for diagnosis and avoids a major surgical operation, which would be required for obtaining tissue for a biopsy. This case emphasises the role of proper history taking, diagnostic work-up and management. It also draws attention to the literature pertaining to the diagnosis of TB based on FNAC, especially in TB endemic areas where sophisticated tests such as the polymerase chain reaction are either unavailable or unaffordable.

A rare case of leishmaniasis recidiva cutis evolving for 31 years caused by Leishmania tropica

A 64-year-old woman presented with erythematous, infiltrative plaques with a central atrophic area on both zygomatic regions. Several yellow-reddish papules were seen at the periphery of the plaques and showed an "apple-jelly" color on diascopy (Fig. 1). No visceral involvement was detected. The past medical history revealed that, at 3 years of age, she had developed an "Oriental sore" on both cheeks that healed with permanent scars. Thirty years later, she noticed an erythematous patch around the scars. She reported a hospital admission 22 years earlier for cutaneous leishmaniasis (CL); this was treated with pentavalent antimonial therapy for 10 days with partial improvement, when she refused further treatment. The lesions worsened in the summer and gradually became disfiguring, which prompted her to seek medical consultation. Laboratory findings were normal. Leishmania antibody titers were negative. Tissue samples were obtained by biopsy from the border of the lesion for culture, polymerase chain reaction (PCR), and histopathologic examination. Histology revealed a dermal infiltrate with tuberculoid granulomas surrounded by lymphocytes, histiocytes, and some plasma cells, but no caseation necrosis. A few Leishmania organisms were found on careful searching (Fig. 2). Leishmania tropica was identified by culture and PCR. A diagnosis of leishmaniasis recidiva cutis (LRC) was made on the basis of the anamnestic data together with the clinical, histopathologic, biologic, and molecular findings. Complete regression was achieved with meglumine antimoniate (Glucantime) given intramuscularly (15 mg Sb(V)/kg/day for 15 days) and cryosurgery with liquid nitrogen. No recurrence was noted during a 12-month follow-up period.

Lichen scrofulosorum in a Saudi adolescent with multifocal tuberculosis

Lichen scrofulosorum in a Saudi adolescent with multifocal tuberculosis

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.

Paracoccidioidomycosis: infiltrated, sarcoid-like cutaneous lesions misinterpreted as tuberculoid leprosy

The authors report a case of paracoccidioidomycosis misinterpreted as tuberculoid leprosy, both on clinical and histological examination. Sarcoid-like cutaneous lesion as the initial presentation is rare in young patient with paracoccidioidomycosis and can simulate other infectious or inflammatory diseases. On histology, tuberculoid granuloma presented similar difficulties. Treatment with dapsone, a sulfonamide derivative, could have delayed the presumed natural clinical course to the classical juvenile type of paracoccidioidomycosis, observed only 24 months after the patient had been treated for leprosy.

Verrucous tuberculid mimicking Kyrle disease

Cutaneous tuberculosis shows wide clinical variation depending upon the virulence of the organism and host immunity. Tuberculids are difficult to diagnose since the organism often cannot be identified or isolated by microscopy, culture or polymerase chain reaction. The diagnosis rests primarily on the identification of a tuberculous focus elsewhere in the body and response to antitubercular therapy. We present the clinicopathological features of an unusual tuberculid in a 30-year-old man, remarkably mimicking Kyrle's disease. He presented with multiple, symmetrically distributed follicular and perifollicular verrucous papules, nodules and plaques on the face, earlobes and extremities since 4 years. Histopathology revealed parakeratotic follicular plug invaginating into the dermis with multiple caseating epithelioid cell granulomas. PCR for M. tuberculosis was negative. The identification of associated axillary tubercular lymphadenitis, strongly positive Mantoux reaction, tuberculoid granulomas on histopathology and complete resolution of the lesions with antitubercular therapy helped in making the diagnosis. We propose the term "verrucous tuberculid" for this entity.

Apoptosis is a major cause of so-called “caseous necrosis” in mycobacterial granulomas in HIV-infected patients

Aim:To demonstrate that so-called “caseous necrosis” is the result of apoptosis and investigate the association of B and T cells, and macrophages with the granulomas and their relationship to some...

Intramuscular Triamcinolone Acetonide for Lupus Miliaris Disseminatus Faciei

Sir, Lupus miliaris disseminatus faciei (LMDF) or acne agminata is a chronic inflammatory disorder that occurs singly or in crops on the eyelids, cheeks and nasolabial folds (1). Clinically it consists of multiple indolent bright-red or brown papules. Histologically, it is characterized by dermal masses of tuberculoid granulomas with central caseation necrosis. LMDF is currently widely considered as a variant of rosacea (2). However, in contrast to rosacea, which shows a chronic course, LMDF runs a self-limiting course with spontaneous resolution of the lesions during 12–24 months, often leaving disfiguring scars. The occurrence of LMDF appears to be related to an immune response to the pilosebaceous units (3), suggesting that immunosuppressants would be good candidates for therapy. We describe here a patient with LMDF who was treated successfully with intramuscularly administered triamcinolone acetonide.

Tuberculose cutanée de l'enfant au Maroc : étude de 30 cas

In Morocco, tuberculosis is still endemic. Cutaneous tuberculosis is ranged the fifth after the pleuro-pulmonary, lymphe node, urogenital and digestive tuberculosis. It mainly affects young people. Few studies of cutaneous tuberculosis are available in this age group. The aim of our study is to emphasize its epidemiological features. Patients and methods It is a retrospective study including all cases of childhood cutaneous tuberculosis observed between January 1981 and December 2004. The diagnosis was based on the confrontation of clinical, immunological, bacteriological and histological data. Results Thirty cases were collected. The mean age was 11 years. The clinical features are as follows: gumma 46.6%, scrofuloderma 36.6%, lupus vulgaris 13.3% and skin tuberculosis chancre 3.3%. The Mantoux test was positive in 67%, tuberculoid granuloma was observed in 78% and the search of Mycobacterium tuberculosis was positive in 13%. Discussion Gumma and scrofuloderma were the most frequent forms as in other Moroccan series. These results attest the endemicity of this affection in our country. The diagnosis relies on the discovery of Mycobacterium tuberculosis; as this situation is rare for the cutaneous location, the diagnosis relies then on the association of clinical and paraclinical criteria.

Opportunistic Posterior Uveal Infections in Renal Transplant Patients

Aims To describe the cases of opportunistic posterior uveal infection diagnosed in renal transplant recipients at a single center over a 10-year period. Methods The study involved 1156 patients who underwent renal transplantation. Five of the recipients were diagnosed with posterior uveal infection. The specific diagnoses were acute retinal necrosis (two cases), cytomegalovirus retinitis (one case), nocardial chorioretinitis (one case), or tuberculoid granuloma (one case). Results The five patients were aged 27 to 55 years, and the interval from renal transplantation to uveal infection ranged from 7 months to 16 years. All patients were receiving immunosuppressive treatment at the time of the posterior uveal infection. Acute retinal necrosis was diagnosed in cases I and II at 2 and 3 years after transplantation, respectively. In both cases, fundus examination revealed moderate vitritis and yellow-white lesions representing confluent retinitis. In case III (cytomegalovirus retinitis), 7 months after transplantation the patient developed extensive hemorrhage and confluent white exudates, periphlebitis, and perivascular sheathing in the right eye. In case IV, culture of a fine-needle aspirate from a well-demarcated, white-yellow, elevated choroidal lesion in the superotemporal region of the macula revealed nocardial infection. Fundus examination of the right eye of case V revealed a small, hypopigmented choroidal lesion superior to the optic disc. The lesion was identified as a choroidal tuberculoid granuloma. Conclusions Opportunistic chorioretinal infections can occur at any time after renal transplantation. So it is important that every kidney recipient undergo regular ophthalmic examinations throughout his or her lifetime.

Etanercept treatment of cutaneous granulomas in common variable immunodeficiency

Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by hypogammaglobulinemia, poor antibody responses, and recurrent bacterial infections, usually of the sinorespiratory tract. A not uncommon complication is granuloma of the lungs, spleen, liver, and/or skin. We report the case of an 18-year-old boy with CVID and chronic granulomas of the left arm (since 13 years of age) refractory to treatment with antibiotics, intravenous immunoglobulin, antifungal agents, systemic and intralesional steroids, IFN-gamma, cyclosporine, methotrexate, hydroxychloroquine, localized radiation therapy, and surgical excision. The lesions improved after treatment with the systemic administration of the TNF-alpha inhibitor etanercept for 1 year. Etanercept prevents soluble TNF from binding to its cell membrane receptor, leading to inhibition of its inflammatory cascade. We recommend further trials of etanercept in patients with CVID with noninfectious recalcitrant granulomas.

Papulonecrotic tuberculid with spontaneous remission

We describe a 62-year-old Japanese woman who had skin lesions involving her extremities, chest and back that showed spontaneous remission. The skin lesions consisted of slightly atrophic scars and crusted, reddish or necrotic papules. A tuberculin test showed induration and bulla, which was regarded as strongly positivity. Histopathologically, a tuberculoid granuloma with necrosis was present in the upper dermis and the deep dermis, including the adipose tissues. Bacterial cultures were not positive from sputum, urine or stool, and the chest X-P was also normal. After skin biopsy, all the lesions disappeared within 1 month. No relapse was noted in the entire body.

Disseminated Hyperkeratotic and Granulomatous Nodules in a Child with Fatal Epstein–Barr‐Virus–Associated Hemophagocytic Lymphohistiocytosis

Hemophagocytic lymphohistiocytosis is a rare and potentially fatal syndrome associated with a variety of genetic, malignant, autoimmune, or infectious conditions. The importance of cutaneous presentations of this syndrome has only recently been brought forward. We report the first case of Epstein-Barr-virus-associated hemophagocytic lymphohistiocytosis presenting with papulonodular and granulomatous skin lesions. A girl of African origin developed several umbilicated papules on her extremities and face at the age of 18 months. She was born in Germany, had never visited Africa, and was otherwise healthy. Over the next 5 months the lesions progressed in size and number and became hyperkeratotic. Histopathologic analysis of early lesions revealed a superficial lympho- and plasmacellular dermatitis with some features of panniculitis. Later biopsy specimens from nodular lesions showed the formation of tuberculoid granulomas in the deep dermis. At the age of 23 months she became severely ill, rapidly developing high fever, hepatosplenomegaly, icterus, pancytopenia, and ascites. On the basis of bone marrow and lymph node biopsies, the diagnosis of hemophagocytic lymphohistiocytosis was established. However, this phenomenon could not be detected in any of the skin specimens. An active Epstein-Barr virus infection was diagnosed by polymerase chain reaction in blood, lymphoid tissue, and skin. Despite chemotherapy with etoposide and cortisone, the girl expired 14 days after clinical onset of her systemic disease.