Escrofuloderma en paciente pediátrico / Scrofuloderma in a pediatric patient

La tuberculosis (TB) cutánea es una forma rara de tuberculosis extrapulmonar y puede tener diversas manifestaciones clínicas. La afectación cutánea puede producirse como resultado de inoculación exógena, diseminación contigua desde un foco de infección, o mediante la propagación hematógena desde un foco distante 1. Las formas multibacilares de localización cutánea siguen siendo, con mucho, las más comunes en los niños 2. La tuberculosis cutánea representa sólo el 1-2% de las formas extrapulmonares de TB. Se clasifica en varias variantes, y la escrofulodermia es una forma de tuberculosis endógena. Afecta a personas de todas las edades, sin embargo, los niños, los adolescentes y los ancianos se ven muy afectados, debido a la incapacidad inmunológica para contener la infección por micobacterias. La escrofulodermia puede presentarse de forma aislada o coexistir con formas pulmonares y diseminadas de TB. Se presenta como nódulos eritematosos que se fistulizan y descargan material caseoso y purulento 3. Los exámenes patológicos revelan abscesos, necrosis y granulomas de tipo tuberculoide (3). La correlación clínica, biológica, patológica y, a veces, la progresión con el tratamiento antibacilar son la clave del diagnóstico 2

Cutaneous tuberculosis (TB) is a rare form of extrapulmonary tuberculosis that can have diverse clinical manifestations. Cutaneous involvement may occur as a result of exogenous inoculation, contiguous dissemination from a focus of infection, or by hematogenous spread from a distant focus (1). Multibacillary forms of cutaneous localization remain by far the most common in children (2). Children and the elderly are greatly affected due to immunological inability to contain the mycobacterial infection. Scrofuloderma can occur in isolation or coexist with pulmonary and disseminated forms of TB. It presents with erythematous nodules that fistulize and discharge caseous and purulent material (3). Anatomopathological examinations reveal abscesses, necrosis and tuberculoid granulomas (3). Clinical, biological, pathological correlation and sometimes progression with antibacillary treatment are the key to diagnosis (2)

Escrofuloderma, una manifestación extrapulmonar de tuberculosis: a propósito de un caso y actualización de esquema de tratamiento en Chile / Scrofuloderma, a manifestation extrapulmonary tuberculosis: about a case and treatment scheme update in Chile

La tuberculosis (TBC) es una enfermedad infecciosa causada por organismos del complejo Mycobacterium tuberculosis. Las presentaciones extrapulmonares constituyen hasta el 25% de los casos de TBC reportados en nuestro país. La TBC cutánea es una manifestación extrapulmonar rara que representa el 1-2% de los casos, siendo el escrofuloderma y el lupus vulgar las formas clínicas más comunes. El escrofuloderma es una manifestación endógena de la infección, como resultado de la extensión contigua a la piel suprayacente desde estructuras adyacentes. La biopsia de piel asociada a técnicas moleculares y cultivo de micobacterias constituyen el gold standard diagnóstico de la TBC cutánea. El tratamiento de la TBC cutánea sigue las mismas recomendaciones que para otras formas de TBC. Presentamos el caso de un paciente con escrofuloderma.

Tuberculosis (TB) is an infectious disease caused by organisms of the Mycobacterium tuberculosis complex. Extrapulmonary presentations may constitutes up to 25% of TB cases. Reported in our country Cutaneous tuberculosis is a rare extrapulmonary manifestation that represents 1-2% of cases, with scrofuloderma and lupus vulgaris being the most common clinical forms. Scrofuloderma is an endogenous manifestation of the infection, because of contiguous extension to the overlying skin from adjacent structures. Skin biopsy associated with molecular techniques and mycobacterial culture constitute the gold standard for diagnosis of cutaneous TB. The treatment of cutaneous TB follows the same recommendations as for other forms of TB. We present the case of a patient with scrofuloderma.

Tuberculose cutânea forma escrofuloderma: relato de caso / Scrofuloderma-shaped cutaneous tuberculosis: case report

Introdução: A tuberculose (TB) é uma doença infecciosa causada pela bactéria Mycobacterium tuberculosis, transmitida a partir da via aérea de pacientes com a forma pulmonar ou laríngea, que atinge cerca de 10 milhões de pessoas no mundo por ano. A forma pulmonar é a mais comum, sendo a TB cutânea responsável por 1,5% dos casos. Descrição do caso: Paciente 58 anos, masculino, apresentando síndrome consumptiva e abscessos em flanco direito, região pré-esternal e hemitórax direito há 60 dias, sem febre ou outros sintomas associados. Ao exame, apresentava lesão fibroelástica com aspecto similar a escrofuloderma. Análise histopatológica evidenciou processo inflamatório inespecífico sem sinais de malignidade. Cultura para fungos negativa e houve positivação da cultura para M. tuberculosis. Discussão: A TB cutânea é uma forma de apresentação rara de TB. Sua forma escrofuloderma é a mais observada em países em desenvolvimento. A lesão do escrofuloderma pode ser única ou múltipla. Todo paciente deve ser submetido a pesquisa de foco de TB subjacente, sendo a coexistência com um processo pulmonar ativo relativamente comum. O tratamento da TB cutânea inclui medidas gerais e terapia farmacológica por seis meses. Conclusão: A tuberculose continua sendo uma doença prevalente em todo mundo. O Brasil está entre os 30 países de alta carga de TB, considerados como prioritários no mundo para controle da doença pela OMS. Nesse contexto, reconhecer as formas de apresentação da doença se torna cada vez mais importante. Devemos sempre nos lembrar da TB como um diagnóstico diferencial em nosso meio.

Introduction: Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis, transmitted from the airways of patients with pulmonary or laryngeal forms, which affects around 10 million people worldwide each year. The pulmonary form is the most common, with cutaneous TB responsible for 1.5% of cases. Case description: A 58-year-old male patient, with consumptive syndrome and abscesses on the right flank, pre-sternal region and right hemithorax for 60 days, without fever or other associated symptoms. Upon physical examination, he presented fibroelastic lesion with an aspect similar to scrofuloderma. Histopathological analysis showed a nonspecific inflammatory process with no signs of malignancy. Culture for bacteria and fungi were negatives, while the culture for M. tuberculosis was positive. Discussion: Cutaneous TB is a rare form of TB. Its scrofuloderma form is the most observed in developing countries. The scrofuloderma lesion can be single or multiple. In every single patient, the underlying TB focus survey should be performed, coexistence with an active pulmonary process being relatively common. The cutaneous TB treatment includes general measures and pharmacological therapy for six months. Conclusion: Tuberculosis remains a prevalent disease worldwide. Brazil is among the 30 countries with a high TB load, considered as priorities in the world for the control of the disease by WHO. In this context, recognizing the forms of presentation of the disease becomes increasingly important. We must always remember TB as a differential diagnosis in our environment.

Tuberculosis cutánea: casuística del Servicio de Dermatología del Hospital Nacional / Cutaneous tuberculosis: casuistry of the Dermatology Service of the Hospital Nacional

RESUMEN Introducción: la tuberculosis cutánea no es frecuente y el diagnóstico es difícil por presentar varias formas clínicas, ninguna especifica de la enfermedad, y pueden requerir varios estudios laboratoriales para confirmarlo. Objetivos: realizar una revisión de los casos de tuberculosis cutánea observados en el Servicio de Dermatología del Hospital Nacional en el periodo 1990 - 2019; determinando sus características demográficas, clínicas, laboratoriales y evolutivas. Metodología: estudio retrospectivo, descriptivo y observacional. Resultados: se diagnosticaron 7 casos; 5 hombres y 2 mujeres; con edades que oscilaban de 4 meses a 74 años y 3 eran nativos. Las formas clínicas fueron escrofuloderma y gomosa en 3 casos; verrugosa en 1. Todos tenían compromiso sistémico (pulmonar en 3 casos, óseo en 2 y ganglionar en 4) y también factores de inmunodepresión, predominando la desnutrición. En 3 casos el diagnóstico se confirmó con el cultivo de lesiones de piel que reportó Mycobacterium tuberculosis en 2 y M. bovis en 1. Los otros casos se diagnosticaron por hallazgos de bacilos ácido - alcohol resistentes en piel u otros órganos, anatomía patológica compatible y respuesta al tratamiento. Todos recibieron el tratamiento específico de la enfermedad con buena respuesta a excepción de un caso con inmunodeficiencia severa que falleció. Conclusiones: la tuberculosis cutánea es rara también en nuestro Servicio, pero su diagnóstico representa un desafío importante y además acompaña a afectación sistémica, por lo que el tratamiento debe ser oportuno.

ABSTRACT Introduction: cutaneous tuberculosis is not frequent and the diagnosis is difficult because it presents several clinical forms, none specific of the disease, and may require several laboratory studies to confirm it. Objectives: to carry out a review of the cases of cutaneous tuberculosis observed in the Dermatology Service of Hospital Nacional in the period 1990 - 2019; determining their demographic, clinical, laboratory and evolutionary characteristics. Methodology: retrospective, descriptive and observational study. Results: 7 cases were diagnosed; 5 men and 2 women; with ages ranging from 4 months to 74 years and 3 were native. The clinical forms were scrofuloderma and gummy in 3 cases; warty in 1. All had systemic involvement (lung in 3 cases, bone in 2 and lymph node in 4) and also immunosuppressive factors, predominantly malnutrition. In 3 cases, the diagnosis was confirmed by the culture of skin lesions that reported Mycobacterium tuberculosis in 2 and M. bovis in 1. The other cases were diagnosed by findings of acid-fast bacilli in skin or other organs, compatible pathological anatomy and response to treatment. All received specific treatment for the disease with a good response, except for one case with severe immunodeficiency that died. Conclusions: cutaneous tuberculosis is also rare in our Department, but its diagnosis represents a significant challenge and also accompanies systemic involvement, so treatment must be timely.

Isoniazid-resistant tuberculous spondylodiscitis associated with scrofuloderma

The extrapulmonary forms of tuberculosis are responsible for about 20% of cases. Scrofuloderma is the cutaneous manifestation secondary to infection in some subcutaneous foci. A 33-year-old patient was admitted to the Clinical Hospital with exudative skin lesions on the back and thorax, initiated 10 months previously, associated with daily fever, and constipation. Spine resonance showed a paravertebral pseudotumoral lesion with T4 and T9 invasion, including vertebral canal and sub-ligament extension. The lesions presented fistulas for paravertebral muscles, lung and skin. Polimerase chain reaction (PCR) proved positive for Mycobacterium tubeculosis in the thorax wound secretion, caracterizing tuberculous spondilodiscitis with scrofuloderma. Treatment was initiated with rifampicin, isoniazid, pyrazinamide and ethambutol with important clinical improvement after the first week. The febrile peaks came to an end and there was improvement in the pattern of the cutaneous lesions. The susceptibility test showed resistance to isoniazid

A Rare Case of Scrofuloderma with Parotid Gland Lymphadenitis / 대한피부과학회지

No abstract available.

Escrofuloderma: la tuberculosis olvidada / Scrofuloderma: the forgotten tuberculosis

INTRODUCCIÓN: La escrofuloderma es una manifestación extrapulmonar de la tuberculosis, siendo su incidencia menor al 1 por ciento de los casos de tuberculosis no pulmonar. Actualmente, la escrofuloderma se presenta con mayor frecuencia en personas inmunocomprometidas o en pacientes que viven en condición de hacinamiento, recintos tales como hogares de ancianos, cárceles o en viviendas de estratos socioeconómicos más bajos. PRESENTACIÓN DEL CASO: A continuación, se presenta el caso de un paciente de 29 años que vive en condiciones de hacinamiento en un recinto penitenciario. Es derivado a policlínico de Medicina Broncopulmonar para estudio con fibrobroncoscopía ante la sospecha de tuberculosis pulmonar. Se pesquisa lesión nodular subcutánea supurativa, asociada a placas cicatriciales rojo-violáceas que, según contexto del paciente, características de las lesiones y resultado de biopsia se diagnosticaron como escrofuloderma. Se inició tratamiento antituberculoso con buena respuesta clínica de las lesiones cutáneas. DISCUSIÓN: Debido al proceso de eliminación que está sufriendo la tuberculosis en Chile, las manifestaciones extrapulmonares de la tuberculosis, entre ellas las cutáneas, representan hoy en día un desafío diagnóstico principalmente por el bajo índice de sospecha que se tiene sobre ellas.

INTRODUCTION: Scrofuloderma is a manifestation of extrapulmonary tuberculosis, being its incidence less than 1 percent of the non-pulmonary cases. Nowadays, scrofuloderma is presented more frequently in immunosuppressed people or in patients living in overcrowded conditions, in enclosures such as nursing homes, prisons or houses from the lowest socioeconomic status. CASE REPORT: We present a clinical case of a 29-year-old patient living in overcrowded conditions in a penitentiary facility. The patient is referred to the neumology Outpatients Unit for study with fibrobronchoscopy for suspected pulmonary tuberculosis. A nodular subcutaneous suppurative lesion is found, associated to purpurish red cicatricial plaques that according to the clinical context of the patient, characteristics of the lesions and biopsy results, were diagnosed as scrofuloderma. Antituberculosis treatment was initiated, with a positive clinical response of the skin lesions. DISCUSSION: Due to the process of elimination that tuberculosis is suffering in Chile, the extrapulmonary manifestations, being the cutaneous manifestations among them, represent a diagnosis challenge principally because of the low index of suspicion.

Delayed Diagnosis of Scrofuloderma Misdiagnosed as a Bacterial Abscess

An 82-year-old woman presented with a four-month history of an ulcerative plaque overlying her left neck. This lesion had developed as a subcutaneous nodule, gradually increased in size, and evolved into ulcers. Before visiting our Dermatology clinic, the patient had been diagnosed as having a bacterial abscess, but treatments with antibiotics were unsuccessful. The presence of a purulent discharge and prominent ulceration caused further confusion as bacterial abscess, and radiologic evaluation on computed tomography also led to the possibilities of secondary lesions from an abscess or malignancy. However, the characteristic appearance of her lesion allowed us to discern cutaneous tuberculosis, especially scrofuloderma. Based on clinical examinations, staining for acid-fast bacilli, and positive findings of polymerase chain reaction, a quick diagnosis of scrofuloderma was made. After that, she was treated successfully with anti-tuberculosis therapy and the ulcer healed. Our case highlights the problem of delayed diagnosis of scrofuloderma presenting as a bacterial abscess. In conclusion, having a high index of suspicion is needed to diagnose cutaneous tuberculosis correctly.

Scrofuloderma - A case series from rural India.

Summary: Cutaneous tuberculosis is the rarest presentation of all the forms of tuberculosis. Scrofuloderma is a frequent manifestation of cutaneous tuberculosis in Indian scenario. Males are affected one and half times more than females. The most common affected age group showing clinical infection is within the first three decades of life. A series of cases mostly malnourished children attending a tertiary care centre in a rural area of central India is being reported. They have presented with a wide spectrum of clinical features, forcing us to establish the final diagnosis by Mantoux test, fine needle aspiration cytology and histopathological examination. The mainstay of treatment remains medical therapy but the underlying cause for severe immunosuppression needs to be ruled out and treated.

A Case of Chronic Mucocutaneous Candidiasis Occurring in a Patient with Scrofuloderma-like BCGitis / 대한의진균학회지

Chronic mucocutaneous candidiasis (CMC) consists of several clinical syndrome characterized by chronic, treatment-resistant, superficial candidal infections of skin, nails and oropharynx. The patients with CMC usually have other manifestations including non-candidal infections, endocrinopathies and autoimmune diseases. These findings suggest that patients with CMC have multiple or complex abnormalities in their immune systems, especially of cell mediated immunity. The scrofuloderma or scrofuloderma-like BCGitis is used to describe the skin reaction and enlargement of regional lymph node with suppuration. In contrast to chronic mucocutaneous candidiasis, BCGitis does not suggest underlying host immune defect in most cases. In our knowledge, there is no report about scrofuloderma-like BCGitis and chronic mucocutaneous candidiasis occurring in the same patient. Herein, we report a case of chronic mucocutaneous candidiasis associated with scrofuloderma-like BCGitis.

Cutaneous tuberculosis in Penang: A 12-year retrospective study

Background Cutaneous tuberculosis (TB) is a form of extrapulmonary tuberculosis. Diagnosis of cutaneous TB is often difficult because of the diverse clinical presentations. The positive yields from cultures are often low. To describe the demographic, clinical, histopathological and bacteriological aspects of cutaneous TB. Materials and Methods This retrospective review looked at cases of cutaneous tuberculosis treated at the Respiratory and Dermatology unit, Penang Hospital from 1996 to 2007. Data were analysed with SPSS 13.0 version. Results A total of 23 cases of cutaneous tuberculosis were reviewed. The male to female ratio was 2.3 to 1. The mean age was 37.7 ± 20.7 years. There were 10 Malays, 9 Chinese, 2 Indians and 2 Indonesian. The types of cutaneous tuberculosis observed were lupus vulgaris (47.8%), tuberculides (17.5%), tuberculosis verrucosa cutis (13.0%), scrofuloderma (13.0%) and primary inoculation TB (8.7%). 43.5% of patients had systemic involvement. Mantoux tests were positive in 85.0% of cases. Skin biopsies were performed in 91.3% of patients and 71.4% of them showed classical histopathologic findings suggestive of tuberculosis. Mycobacterium tuberculosis was isolated in the culture from 28.6% of patients. Localized diseases were found more often in BCG-vaccinated individuals. Regional lymphadenopathy was noted more often in patients with disseminated disease. No correlation was found between Mantoux reactivity and the extent of disease. Conclusion Lupus vulgaris was the commonest form of cutaneous tuberculosis. Cultures were positive in only a small proportion of patients. Almost half of our patients had systemic involvement. The presence of regional lymphadenopathy often indicates disseminated disease. Patients without BCG vaccination were at higher risk of disease dissemination.

A Case of Scrofuloderma-like BCGitis Near the BCG Vaccination Sit / 대한피부과학회지

A 10-month-old male patient was seen with a nodular lesion on his left upper arm which developed several months after BCG vaccination. Physical examination revealed a bean sized, irregular surfaced, erythematous pustular nodule on the left upper arm at a place different from the vaccination site. Histopathologic examination of the nodule on the left upper arm showed tubercles composed of mononuclear cells, epithelioid cells and langhans type giant cells in the dermis. Caseation necrosis within the typical tubercles was noted. Prominent improvement of the lesion was observed 4 months after oral medication with isoniazid and rifampicin.

A Case of Scrofuloderma with Cervical Lymphadenitis / 대한피부과학회지

Scrofuloderma results from contiguous extension of an underlying tuberculous focus secondary to local tissue breakdown. The underlying focus may be a tuberculous bone or joint or even epididymis, but it occurs most commonly over a lymph node, particularly the cervical lymph node. A 29-year-old man presented with a tender, erythematous, linear, fluctuating plaque and nodules on the right side of his neck. He had pulmonary and intestinal tuberculosis. A biopsy specimen from the skin lesion showed caseation necrosis surrounded by granulomatous infiltration, composed of epithelioid cells, mononuclear cells and Langhans' giant cells in the dermis. Acid-fast bacilli were identified on AFB staining. Herein, we report a typical case of scrofuloderma associated with cervical lymphadenitis.

Scrofuloderma Derived from Tuberculous Sternoclavicular Osteoarthritis / 대한피부과학회지

Scrofuloderma, also called tuberculosis cutis colliquativa, is a subacute form of cutaneous tuberculosis, which is characterized by subcutaneously-located, cold abscess formation and secondary changes of the overlying skin. Recently, the occurrence of cutaneous tuberculosis has decrease due to improved quality of life and development of effective anti-tuberculous drugs. However, the tendency of diminution of scrofuloderma has grown smaller because the number of old and immunocompromised patients has increased. We report a rare case of scrofuloderma derived from tuberculous sternoclavicular osteoarthritis in a 71-year old woman.

Role of fine needle aspiration cytology of lymphnodes in the diagnosis of cutaneous tuberculosis.

Background: Lymph node involvement in cutaneous tuberculosis is primarily seen in patients with Scrofuloderma. However, patients with lupus vulgaris and TBVC sometimes present with regional lymphadenopathy. Demonstration of organism in skin biopsies by ZN stain and culture is time consuming and often unrewarding when bacillary load is considerably low. Fine needle aspiration cytology (FNAC) is an economical, dependable, quick and cost effective tool for an early diagnosis compared to biopsy studies. Aim: The present study was undertaken to assess the utility of FNAC of lymphnodes in diagnosis of cutaneous tuberculosis. Method: FNAC of affected lymph nodes in Scrofuloderma and lymph nodes draining the lesions in TBVC and lupus vulgaris was carried out followed by skin biopsy in 26 patients of clinically suspected cases of cutaneous tuberculosis. Observations: Smears revealed epithelioid cell granulomas over a necrotic background. AFB could not be demonstrated by ZN stain. Histopathological studies of skin biopsies revealed epithelioid cell granulomas and Langhans’ giant cells. Biopsies were also negative for AFB by ZN stain and culture. All the patients responded well to standard antituberculous regimen. Conclusions: FNAC of lymph nodes in cases of cutaneous tuberculosis is a useful procedure that helps in arriving at diagnosis within a reasonable time frame.

Two Cases of Scrofuloderma / 대한피부과학회지

Scrofuloderma results from a direct extension of an underlying tuberculosis focus such as the lymph node, bone or joint to the underlying skin, and is often associated with pulmonary tuberculosis. One 72-year-old man presented with erythematous swollen patch with scales on the left hand and erythematous swollen patch on the left elbow. He had tuberculous osteomyelitis of left elbow. And another patient who is a 59-year-old man presented with hemorrhagic, purulent ulcers with crust and exudate on the left and right chest. Each size of ulcers are 6.0x5.0cm and 5.0x5.0cm. He had reactive pulmonary tuberculosis and tuberculous spondylitis. Biopsy specimens from the skin showed lymphocytes, epitheloid cells, and Langerhan's giant cells with caseation necrosis. Acid-fast bacilli were identified on AFB staining. We report two unusual cases of scrofuloderma associated with tuberculous osteomyelitis and pulmonary tuberculosis respectively.

A Case of Scrofuloderma Caused by Mycobacterium fortuitum / 감염

Mycobacterium fortuitum causes a wide spectrum of cutaneous and extracutaneous diseases. Trauma may precede the primary cutaneous disease. Granulomatous nodules, ulcers, scrofuloderma, abscess, and sporotrichoid lesions have been described. Extracutaneous manifestations include postoperative vasculitis, endocarditis, pericarditis, mediastinitis, osteomyelitis, and disseminated disease. However, there have been few reports of scrofuloderma caused by M. fortuitum in the literature. We report a case of scrofuloderma due to M. fortuitum, which developed on the right inguinal area in a 8-year old boy. He had received a tearing injury to his gluteal region in a swimming pool. M. fortuitum was isolated by culture of skin specimen on Lowenstein- Jensen medium and subsequently identified by selected biochemical tests and comparative sequence analysis of rpoB gene (306 bp). Eight-week treatment with tetracycline after incision and drainage along with infrared irradiation resulted in complete resolution of the lesion.