Assuntos
Vacina BCG , Lúpus Vulgar , Fator de Transcrição STAT1 , Humanos , Vacina BCG/efeitos adversos , Vacina BCG/administração & dosagem , Fator de Transcrição STAT1/genética , Lúpus Vulgar/diagnóstico , Lúpus Vulgar/genética , Lúpus Vulgar/tratamento farmacológico , Lúpus Vulgar/imunologia , Predisposição Genética para Doença , Masculino , Mycobacterium bovis/isolamento & purificação , Mycobacterium bovis/imunologia , FemininoRESUMO
Lupus vulgaris (LV) is a type of paucibacillary cutaneous tuberculosis that can occur due to inoculation, lymphatic, or hematogenous route. It occurs in a previously sensitized individual with high immunity to tuberculosis. LV can have different morphology of presentation, which can lead to difficulty in diagnosis. The Tuberculin test is strongly positive. Histopathology will show epithelioid granulomas in the superficial dermis and acid-fast bacilli rarely demonstrable within the granulomas. Dermoscopy will show focused linear vessels on a yellow to orange background. Culture is the gold standard for diagnosis, but its positivity rate is low. Mycobacterium tuberculosis bacilli can be detected using polymerase chain reaction from the lesions. Histopathology, tuberculin test, dermoscopy, molecular test, and culture would help diagnose LV. This review discusses the introduction, pathogenesis, clinical features, differential diagnosis, investigations, complications, and treatment of lupus vulgaris in detail. This review can help the dermatologist understand the condition better with appropriate diagnosis and therapy.
Assuntos
Lúpus Vulgar , Mycobacterium tuberculosis , Tuberculose Cutânea , Humanos , Lúpus Vulgar/diagnóstico , Lúpus Vulgar/tratamento farmacológico , Lúpus Vulgar/patologia , Tuberculose Cutânea/diagnóstico , Granuloma , Teste TuberculínicoRESUMO
Cutaneous tuberculosis (CTB) is an uncommon form of extra-pulmonary tuberculosis accounting for ≤2% of mycobacterium tuberculosis cases and is more often reported from developing countries. Tuberculid, a cutaneous hypersensitivity reaction to mycobacteria or its fragments, is a another rare cutaneous manifestation seen in association with tuberculosis of other organ systems including tuberculous lymphadenitis, pulmonary tuberculosis, etc. Co-occurrence of a tuberculid with CTB is extremely rare. Herein we report a childhood case of lupus vulgaris, a type of CTB, associated with an atypical presentation of tuberculid.
Assuntos
Lúpus Vulgar , Mycobacterium tuberculosis , Tuberculose Cutânea , Humanos , Criança , Tuberculose Cutânea/complicações , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Lúpus Vulgar/diagnóstico , Lúpus Vulgar/tratamento farmacológicoRESUMO
Cutaneous tuberculosis classically presents as Lupus vulgaris, scrofuloderma, tuberculosis verrucose cutis and tubercular abscess. Hypersensitivity reaction to the bacilli leads to Lichen scrofulosorum and papulonecrotic tuberculids. At the same time, it can have myriad of clinical presentations, many of which are still undescribed. It is important to regularly update ourselves with these unusual manifestations so as to ensure early treatment and reduction of overall morbidity. In this case series tuberculosis manifesting as rapidly progressing diffuse facial granulomas, sporotrichoid tuberculosis, tuberculosis mimicking squamous cell carcinoma, scrofuloderma as tubercular ulcer, lupus vulgaris with nasal septal perforation, lupus vulgaris resembling furuncle, psoriasis, dermatitis and BT Hansen are described in immunocompetent individuals. These cases highlight the importance of recognition of atypical forms of cutaneous tuberculosis to minimize scarring and dissemination of bacilli.
Assuntos
Carcinoma de Células Escamosas , Lúpus Vulgar , Tuberculose Cutânea , Humanos , Lúpus Vulgar/diagnóstico , Lúpus Vulgar/tratamento farmacológico , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológicoRESUMO
ABSTRACT The authors present a case of lupus miliaris disseminatus faciei , a rare skin disease of unknown etiology, which may cause unaesthetic scarring due to its difficult treatment. The histopathological examination of epithelioid granulomas with caseating necrosis, together with the clinical features, are important for diagnosis and early treatment with better results. Despite difficult and unsatisfactory treatment, there are ongoing studies on therapy to improve aesthetic and social impairment. This case report describes an initial misdiagnosis delaying appropriate treatment, and highlights the value of physical examination and clinical judgment for another pathological examination, whenever necessary, aiming at better treatment outcomes in daily practice.
RESUMO Os autores apresentam um caso de lupus miliaris disseminatus faciei , uma dermatose rara, de etiologia desconhecida, que pode deixar cicatrizes não estéticas, pela dificuldade de tratamento. O exame histopatológico de granulomas compostos por células epitelioides, com necrose caseosa, e as características clínicas, são importantes para o diagnóstico e tratamento precoce, com melhores resultados. Apesar do tratamento difícil e insatisfatório, há estudos em andamento sobre terapias para melhorar o comprometimento estético e social. Este relato de caso descreve um diagnóstico inicial errôneo, que atrasou o tratamento adequado, e destaca o valor do exame físico e raciocínio clínico para solicitar outro exame anatomopatológico, quando necessário, de forma a obter melhores desfechos com o tratamento, na prática diária.
Assuntos
Humanos , Feminino , Adulto , Doenças Palpebrais/patologia , Doenças Palpebrais/tratamento farmacológico , Dermatoses Faciais/patologia , Dermatoses Faciais/tratamento farmacológico , Tetraciclina/uso terapêutico , Prednisona/uso terapêutico , Isotretinoína/uso terapêutico , Cicatriz , Tacrolimo/uso terapêutico , Rosácea/patologia , Rosácea/tratamento farmacológico , Dapsona/uso terapêutico , Granuloma/patologia , Granuloma/tratamento farmacológico , Lúpus Vulgar/patologia , Lúpus Vulgar/tratamento farmacológico , Minociclina/uso terapêuticoRESUMO
Cutaneous tuberculosis occurs in 1-2% of world cases of tuberculosis and more common in tropical countries. It presents with different clinical forms. Unusual clinical presentations are not uncommon and awareness of these will help in suspecting and managing these patients successfully. Lupus pernio like lupus vulgaris, tuberculosis of glans penis and lichen scrofulosorum on the distal parts of limbs are presented here because of their unusual clinical presentation.
Assuntos
Dermatoses Faciais/patologia , Dermatoses da Perna/patologia , Lúpus Vulgar/patologia , Doenças do Pênis/patologia , Tuberculose Cutânea/patologia , Tuberculose dos Genitais Masculinos/patologia , Adulto , Antituberculosos/uso terapêutico , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/tratamento farmacológico , Antebraço/patologia , Humanos , Dermatoses da Perna/diagnóstico , Dermatoses da Perna/tratamento farmacológico , Lúpus Vulgar/diagnóstico , Lúpus Vulgar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/tratamento farmacológico , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Tuberculose dos Genitais Masculinos/diagnóstico , Tuberculose dos Genitais Masculinos/tratamento farmacológicoAssuntos
Pavilhão Auricular/patologia , Lúpus Vulgar/diagnóstico , Pele/patologia , Adulto , Antituberculosos/uso terapêutico , Dermatomicoses/diagnóstico , Diagnóstico Diferencial , Quimioterapia Combinada , Pavilhão Auricular/imunologia , Pavilhão Auricular/microbiologia , Feminino , Humanos , Leishmaniose Cutânea/diagnóstico , Hanseníase/diagnóstico , Lúpus Vulgar/tratamento farmacológico , Lúpus Vulgar/imunologia , Lúpus Vulgar/microbiologia , Mycobacterium tuberculosis/imunologia , Mycobacterium tuberculosis/isolamento & purificação , Sarcoidose/diagnóstico , Pele/imunologia , Pele/microbiologia , Teste TuberculínicoAssuntos
Antituberculosos/administração & dosagem , Lúpus Vulgar/tratamento farmacológico , Lúpus Vulgar/patologia , Dermatopatias Papuloescamosas/patologia , Biópsia por Agulha , Criança , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Lúpus Vulgar/diagnóstico , Pescoço , Medição de Risco , Índice de Gravidade de Doença , Dermatopatias Papuloescamosas/diagnóstico , Resultado do TratamentoRESUMO
Most common form of cutaneous tuberculosis (TB) is lupus vulgaris (LV). Atypical presentation of LV is rare and may lead to delay in diagnosis and hence increase in morbidity. Here, we report a case of sporotrichoid form of LV in a 38 year old male who presented as cutaneous lesions mimicking mycetoma. High index of clinical suspicion and relevant investigations play a vital role in confirmation of diagnosis wherever atypical form of cutaneous TB is suspected.
Assuntos
Lúpus Vulgar/diagnóstico , Tuberculose Cutânea/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Humanos , Lúpus Vulgar/tratamento farmacológico , Lúpus Vulgar/microbiologia , Masculino , Micetoma/diagnóstico , Esporotricose/diagnóstico , Tuberculose Cutânea/complicações , Tuberculose Cutânea/microbiologiaAssuntos
Antituberculosos/uso terapêutico , Estética , Lúpus Vulgar/complicações , Deformidades Adquiridas Nasais/etiologia , Pele/patologia , Biópsia , Face , Feminino , Humanos , Lúpus Vulgar/diagnóstico , Lúpus Vulgar/tratamento farmacológico , Lúpus Vulgar/imunologia , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
Cutaneous manifestations in sarcoidosis are seen in 25-35% of patients with systemic disease and may be the sole manifestation in few patients. It is known that isolated cutaneous sarcoidosis is a great mimicker and can be easily misdiagnosed as other granulomatous conditions especially lupus vulgaris in regions with high burden of tuberculosis (TB). Here we present a case with cutaneous sarcoidosis who was initially misdiagnosed and treated as bifocal lupus vulgaris with antitubercular therapy (ATT) for 6 months. This nonresponsiveness to therapy prompted us to investigate the patient further for other differentials, failing which a diagnosis of cutaneous sarcoidosis was made and the patient was treated with oral steroids and methotrexate with complete clearance of lesions after 14 weeks of therapy. Our case reemphasizes the value of therapeutic trial of ATT in diagnosis of cutaneous TB and highlights the remarkable clinical mimic of sarcoidosis with lupus vulgaris.
Assuntos
Antituberculosos/administração & dosagem , Lúpus Vulgar/diagnóstico , Sarcoidose/diagnóstico , Dermatopatias/diagnóstico , Erros de Diagnóstico , Humanos , Lúpus Vulgar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Sarcoidose/patologia , Dermatopatias/patologiaRESUMO
Lupus vulgaris is a common form of cutaneous tuberculosis in China, mostly involving the head and neck region. Turkey ear is a clinically descriptive term, used for a massively enlarged earlobe with bluish-red or violaceous indurated plaques and nodules, which can be a sign of lupus vulgaris. A 47-year-old female presented with edema and reddish ulcerated lesions on both ears which was diagnosed as lupus vulgaris by conventional laboratory investigations and the patient showed good response to antituberculous therapy. Occurrence of turkey ears in lupus pernio (sarcoidosis) should also be mentioned here as this presentation was originally described in this condition. Two case reports of turkey ear have been reported with cutaneous tuberculosis (not bilateral). However, occurrence of bilateral turkey ears in cutaneous tuberculosis has not been described so far in the literature.