Vulvar ulcerative cutaneous tuberculosis secondary to genital tract tuberculosis.

Tuberculosis is a chronic infectious disease that gradually poses a certain threat to public health and economic growth. Tuberculosis typically affects the lungs, pleura, and lymph nodes and rarely the skin. Cutaneous tuberculosis manifesting as ulcerated lesions is also rare and often misdiagnosed and missed by clinicians. Here, the authors report a 29-year-old female patient presenting a vulvar ulcer for 10 months, accompanied by irregular menstruation and increased vaginal secretions. After a skin biopsy and endometrial PCR testing, it was finally diagnosed as vulvar ulcerative cutaneous tuberculosis secondary to genital tuberculosis. Anti-tuberculosis treatment was effective. Cutaneous tuberculosis is called a great imitator. In order to facilitate the diagnosis and treatment of tuberculosis by clinicians, the authors systematically reviewed this disease as well.

Escrofuloderma: tuberculosis cutánea y pulmonar asociada a coinfección COVID-19: reporte de caso / Scrofuloderma, cutaneous and pulmonary tuberculosis associated with COVID-19: report of one case

Cutaneous tuberculosis represents 1-1.5% of extrapulmonary tuberculosis, including a variety of clinical conditions. Scrofuloderma and lupus vulgaris are the most common forms. We report a 49-year-old woman who sought medical attention through tele-dermatology concerning a cervical nodule associated with suppuration and cutaneous involvement. The diagnoses of scrofuloderma and pulmonary tuberculosis were confirmed, and during her evolution she presented a coinfection with SARS-CoV-2. The possible associations between tuberculosis and COVID-19 were reviewed.

Unilateral lymphoedema of lower limb: an unusual presenting feature of hidden tuberculosis verrucosa cutis of foot.

A 42-year-old Indian farmer presented with gradually progressive swelling of the right lower limb for the last 20 years. There were few verrucous plaques over the right foot for the same duration. Those plaques were initially ignored and mistaken as lymphoedema-induced secondary changes by primary care physicians. Histopathology of the skin lesion showed pseudoepitheliomatous hyperplasia with upper dermal granulomatous infiltrate and a diagnosis of tuberculosis verrucosa cutis was suspected. Subsequently, the lesions as well as lymphoedema improved significantly with antitubercular therapy.

Lichenoid granulomatous dermatitis as a tuberculid in association with spondylitis due to Mycobacterium tuberculosis.

Lichenoid granulomatous dermatitis (LGD) is a histopathologic pattern with a band-like lymphocytic infiltrate, typical of lichenoid dermatitis, combined with dermal histiocytes and granulomatous inflammation. Prior reports have described cases of LGD caused by non-tuberculous mycobacteria, with evidence of intralesional acid-fast bacilli or mycobacterial DNA. Herein, we report a patient with pulmonary and extrapulmonary Mycobacterium tuberculosis infection who developed LGD. No evidence of M. tuberculosis was detected within the cutaneous lesions, suggesting a potential delayed-type hypersensitivity reaction to tuberculosis.

Atypical Variant of Cutaneous Tuberculosis Presentation in an Adult HIV-Infected Patient in an Emergency Department in Haiti.

The incidence of tuberculosis (TB) has increased in the 21st century due to a high prevalence of the human immunodeficiency virus (HIV) infection and multidrug-resistant (MDR) pulmonary TB. HIV infection, diabetes mellitus, and other immune deficiencies decrease cure rates, increase mortality, and increase the incidence of MDR pulmonary TB. Tuberculosis is the most virulent opportunistic pathogen worldwide for patients living with HIV. This case documents rare clinical manifestation of cutaneous tuberculosis (CTB) seen in an emergency department in Gonaives, Haiti. Cutaneous TB can occur either from the spread of TB from an endogenous origin or from the entry of mycobacteria into the skin. The host's immune response to mycobacteria is an important factor. There are several findings that support diagnosis of a tuberculid, including failure to detect mycobacterium TB in stains or cultures of affected tissue, frequent resolution of skin lesions with anti-TB therapy, a strongly positive tuberculin skin test, a positive interferon-γ release assay, presence of an endogenous TB infection, and granulomatous tissue present in histopathology. This case study illustrates the challenges providers face to diagnose a patient with CTB and the many differential diagnoses that must be considered. Once a definitive diagnosis has been made, this article highlights disease course, progression, and treatment plan.

Lymphatic spread in an immunocompetent adult.

Cutaneous tuberculosis with lymphatic spread is rarely described. We report the case of a woman aged 38, immunocompetent, working in a fruit sorting center, who consulted us for ulceration of the left third finger that had persisted for four months, following a prick from a prickly pear. Physical examination revealed a nodular, erythematous, and ulcerative lesion of the left third finger, associated with inflammatory subcutaneous nodules arranged in a line along the ipsilateral upper extremity and an ipsilateral axillary lymph node. Laboratory tests and chest X-ray were normal. Pathological examination revealed granulomatous chronic inflammation without necrosis. PCR detected DNA from Mycobacterium tuberculosis. No extracutaneous tuberculosis locations were detected. A tuberculous chancre by direct inoculation was therefore diagnosed. The patient received quadruple therapy (rifampicin + isoniazid + pyrazinamide + ethambutol) for 2 months, followed by a combination therapy based on isoniazid and rifampicin for 6 months. Marked regression of the cutaneous lesions occurred after 1 month of first-line therapy. A tuberculous chancre is a rare form of cutaneous tuberculosis, with possible lymphatic spread, in immunocompromised patients but also in immunocompetent children and young adults.

Immune-mediated tuberculous uveitis - A rare association with papulonecrotic tuberculid.

The tuberculids are a group of distinct clinicopathological form of skin lesions representing hypersensitivity reaction to hematogenous dissemination of Mycobacterium tuberculosis or its antigen from an underlying active or a silent focus of tuberculosis elsewhere in the body in an individual with a strong antituberculous cell-mediated immunity and by definition do not show bacilli on special stains and are culture-negative. Ocular involvement can occur in tuberculosis, both due to direct invasion by the bacilli as well as an immune-mediated reaction; however, immune-mediated tuberculous uveitis occurring as a hypersensitivity response in association with PNT has hardly been reported in the literature. Here we report one such rare case.

Tuberculosis verrucosa cutis presenting with unilateral elephantiasis nostras verrucosa of the left lower limb: A rare entity.

Elephantiasis nostras verrucosa is used to describe lymphedema of the lower limbs caused by a nonfilarial etiology. Infective etiologies include bacterial and fungal infections along with chronic venous stasis, postirradiation, congestive heart failure, obesity, and malignancies, all causes leading to lymphatic obstruction and edema. We herein describe a case of a 70-year-old male who presented with diffuse nonpitting edema of the entire left lower limb with cobblestoning of the surface with a positive Kaposi-Stemmer sign and presence of a verrucous plaque over the left ankle. Histopathology of the verrucous plaque revealed it to be tuberculosis verrucosa cutis (TVC). We report this rare presentation of TVC as a cause of unilateral lymphedema.

Rare cutaneous tuberculosis in Sub-Saharan Africa developed on discoid lupus erythematous lesion.

Lupus vulgaris is a common presentation of cutaneous tuberculosis (TB), but its ulcerative or vegetating form also called vorax is rare.We report a case of lupus vulgaris in its vorax form, which occurred in a patient with discoid lupus erythematous. A 42-year-old patient monitored for chronic lupus erythematosus consulted again for a facial tumor and fever. Physical examination revealed painful ulcerative and crusted lesions on an old discoid lupus lesion and covered the entire upper lip. Similar lesions were noted on cheeks. Moreover, there were cervical lymphadenopathy, a bilateral pulmonary condensation syndrome, and dysphonia. Cutaneous histopathology had revealed a tuberculoid granuloma without caseating, and nucleic acid amplification tests (GeneXpert®) performed on sputum were positive. Thus, the diagnosis of multifocal TB with skin involvement of vorax type was confirmed. The outcome was favorable following TB treatment. Our observation is distinctive as it is a granulomatosis and ulcerative form of lupus vulgaris, which occurred on a discoid lupus erythematous lesion. This is a rare form of lupus vulgaris. This scarcity can be explained by diagnostic difficulties as there are numerous differential diagnoses and histopathology is not often helpful.

Tuberculous cellulitis: diseases behind cellulitislike erythema.

An 89-year-old man presented with an inflammatory erythematous plaque on the left thigh that closely mimicked cellulitis. Empiric therapies with ordinary antibiotics were not effective. A skin biopsy showed epithelioid cell granulomas throughout the dermis and subcutis. Ziehl-Neelsen stain revealed numerous acid-fast bacilli. Additionally, Mycobacterium tuberculosis was isolated from a skin biopsy specimen as well as gastric fluid and sputum cultures. He was diagnosed with tuberculous cellulitis with pulmonary tuberculosis. Cellulitis is a common disease seen by dermatologists; however, sometimes other diseases may masquerade as this banal illness. Among them, cutaneous tuberculosis should be excluded because of its clinical significance. Most cases of cutaneous tuberculosis are symptom free, but tuberculous cellulitis is sometimes painful. Therefore, cutaneous tuberculosis should always be considered in the differential diagnosis of a cellulitislike rash if the lesions do not respond to ordinary antibiotic therapy, especially in countries with a high incidence of tuberculosis.

Concomitant metastatic cutaneous tuberculous abscesses and Pott disease in an immunocompetent patient.

Tuberculosis affects one-third of the world's population. The incidence of extrapulmonary tuberculosis including cutaneous and skeletal manifestations has increased in the last decades. The authors report a clinical case of concomitant metastatic cutaneous abscesses and Pott disease in an immunocompetent patient, a rare presentation of tuberculosis.

Molluscum-like papules as a presentation of early papulonecrotic tuberculid in association with nodular tuberculid in a male with asymptomatic active pulmonary tuberculosis.

BACKGROUND/OBJECTIVES: The clinical and histopathologic findings of a rare simultaneous occurrence of papulonecrotic tuberculid and nodular tuberclid in a patient with active but asymptomatic pulmonary tuberculosis are presented. Papulonecrotic tuberculid was observed at a very early stage, presenting as molluscum-like lesions. This has been described once in the literature. This was observed in conjunction with lesions compatible with the rare clinicopathologic variant of nodular tuberculid. Critical to the diagnosis of active pulmonary tuberculosis was the use of induced sputum testing, which confirmed the diagnosis despite the lack of a cough and a chest x-ray negative for active tuberculosis. METHODS/RESULTS: A 40-year-old male presented with a 2-week history of fever and a skin eruption consisting of molluscum-like papules on the ears, arms, and abdomen and nodules on his legs. Biopsies from both lesions were consistent with papulonecrotic and nodular tuberculid, respectively. Despite the lack of any respiratory symptoms, induced sputum grew Mycobacterium tuberculosis, and the lesions resolved on antituberculous therapy. CONCLUSIONS AND RELEVANCE: Tuberculids are rare in Western countries but must be considered in the differential diagnosis of eruptions in patients from endemic countries. An active tuberculous focus must be sought out.