RESUMEN
Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.
Asunto(s)
Artritis Reactiva/inmunología , Inmunocompetencia , Huésped Inmunocomprometido , Tuberculosis Cutánea/inmunología , Tuberculosis Cutánea/patología , Antituberculosos/uso terapéutico , Etambutol/uso terapéutico , Humanos , Isoniazida/uso terapéutico , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/inmunología , Úlcera Cutánea/patología , Resultado del Tratamiento , Tuberculosis Cutánea/tratamiento farmacológico , Adulto JovenRESUMEN
A 63-year-old black female patient with blisters and exulcerations on the face, neck, upper limbs, and subsequent evolution with hypochromic sclerotic areas and alopecia, is reported. Chronic hepatitis C and presence of high levels of porphyrins in urine were demonstrated. There was complete remission with the use of hydroxychloroquine, photoprotection, and treatment of hepatitis. Significant sclerodermoid involvement of the skin as a manifestation of porphyria cutanea tarda secondary to hepatitis C emphasizes the importance of diagnostic suspicion regarding skin manifestation in order to indicate the appropriate therapy, and to minimize the hepatic morbidity.
Asunto(s)
Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/patología , Porfiria Cutánea Tardía/etiología , Porfiria Cutánea Tardía/patología , Esclerodermia Localizada/etiología , Esclerodermia Localizada/patología , Alopecia/etiología , Femenino , Hepatitis C Crónica/terapia , Humanos , Persona de Mediana Edad , Porfiria Cutánea Tardía/terapia , Esclerodermia Localizada/terapia , Resultado del TratamientoRESUMEN
Abstract: A 63-year-old black female patient with blisters and exulcerations on the face, neck, upper limbs, and subsequent evolution with hypochromic sclerotic areas and alopecia, is reported. Chronic hepatitis C and presence of high levels of porphyrins in urine were demonstrated. There was complete remission with the use of hydroxychloroquine, photoprotection, and treatment of hepatitis. Significant sclerodermoid involvement of the skin as a manifestation of porphyria cutanea tarda secondary to hepatitis C emphasizes the importance of diagnostic suspicion regarding skin manifestation in order to indicate the appropriate therapy, and to minimize the hepatic morbidity.