Cutaneous tuberculosis and HIV infection at a referral centre in Rio de Janeiro, Brazil

BACKGROUND Cutaneous tuberculosis (CTB) is a rare extrapulmonary form of tuberculosis (TB). Despite the increase in the number of cases of TB and HIV, few cases of CTB have been reported. OBJECTIVE To describe CTB cases among patients with HIV infection from a cohort with tuberculosis. METHODS We describe a series of 15 CTB and HIV cases, based on secondary data from 2000 to 2016. Diagnosis was based on isolation of Mycobacterium tuberculosis in culture or clinical response to anti-tuberculous treatment associated with positive smear or histopathologic findings from affected skin or an adjacent lymph node. FINDINGS Scrofuloderma was present in 12 (80%) patients and solitary gumma in three (20%) patients. One case of scrofuloderma was associated with papulonecrotic tuberculid. Seven (46.6%) patients had pulmonary TB. Diagnosis was based on culture in nine patients (60%). The median CD4 cell count was 262 cells/µL. All patients were cured at the end of treatment (median time 6 months). Three patients presented with immune reconstitution inflammatory syndrome. CONCLUSIONS In this study, CTB associated with HIV infection presented as localised forms or in association with pulmonary TB. In patients with HIV who have subacute and chronic skin lesions, CTB should be considered in differential diagnosis, which may represent a good opportunity for early diagnosis of active TB.

Primary inoculation skin tuberculosis by accidental needle stick.

A 42-year-old female laboratory worker presented with a left index finger skin lesion after an accidental prick while handling samples of a cultural exam of Mycobacterium tuberculosis. Surgical excision was performed and pathology analysis revealed a dermic chronic inflammatory process with no granulomas. Later, a non-painful lymphadenopathy appeared in the left axilla as well as brownish indurated skin lesions in the lower limbs consistent with erythema nodosum. Fine needle aspiration biopsy of the lymph node revealed epithelioid granulomas, Langhans' multinucleated giant cells and the presence of acid-fast bacilli. Standard tuberculosis treatment resulted in regression of lesions and no relapses occurred in the 2-year follow-up period.

Cutaneous manifestations of tuberculosis.

Cutaneous involvement is a rare manifestation of tuberculosis (TB). The correct diagnosis is often significantly delayed because cutaneous TB is not routinely considered in the differential diagnosis or because investigations fail to reveal the presence of Mycobacterium tuberculosis. The clinical features of cutaneous TB are diverse, and result from exogenous and endogenous spread of M. tuberculosis and from immune-mediated mechanisms. The recognition of cutaneous TB is important, as the diagnosis is frequently overlooked resulting in delayed treatment.

Lupus miliar diseminado de la cara asociado a quistes epidérmicos / Lupus miliaris disseminatus faciei associated with epidermal cysts

El lupus miliar diseminado de la cara (LMDF) es una enfermedad granulomatosa crónica, con predisposición a localizarse en el área central de la región facial. Su imagen histológica característica corresponde a granulomas epitelioides con necrosis caseosa. Su asociación con quistes epidérmicos se ha descrito en escasas ocasiones en la literatura médica. Se presenta un caso de LMDF asociado a quistes epidérmicos en una paciente de raza caucasiana. Esta asociación sugiere que la rotura de los quistes epidérmicos podría estar relacionada con la aparición de LMDF. Sin embargo, existen probablemente otros factores que pueden también contribuir a su patogénesis

Lupus miliaris disseminatus faciei (LMDF) is a chronic granulomatous disease, which tends to be located on the central part of the face. Its typical histological image is one of epithelioid granulomas with caseous necrosis. Its association with epidermal cysts has been described on few occasions in literature. We present a case of LMDF associated with epidermal cysts in a female Caucasian patient. This association suggests that the rupture of the epidermal cysts may be related to the appearance of LMDF. However, there are probably other factors that may also contribute to its pathogenesis

Cutaneous tuberculosis of the penis and sexual transmission of tuberculosis confirmed by molecular typing.

A case of culture-positive primary cutaneous Mycobacterium tuberculosis infection of the penis was diagnosed in a male patient; 1 year later, endometrial tuberculosis was diagnosed in the patient's wife. These organisms were confirmed to be indistinguishable by use of molecular techniques.

[Two children with extrapulmonary symptoms due to tuberculosis]. / Twee kinderen met extrapulmonale klachten door tuberculose.

Two patients came to their general practitioner for relatively minor problems: a 4-year-old boy came with a red eye and a 10-year-old girl with red foot soles. They came from Pakistan and Vietnam respectively. Their symptoms were due to tuberculosis, which diagnosis was established by Mantoux test and culture of a stomach aspirate. They were treated accordingly with isoniazid, rifampicin and pyrazinamide and with isoniazid, rifampicin and ethambutol respectively. These cases stress the importance of knowledge of the extrapulmonary manifestations of tuberculosis. As treatment exists and adequate treatment can diminish the reservoir of tuberculosis bacteria, early diagnosis can prevent the morbidity, spread and mortality of tuberculosis.

Non-respiratory tuberculosis with Mycobacterium tuberculosis after penetrating lesions of the skin: five case histories.

Tuberculosis is primarily transmitted from person to person via the respiratory route. We describe five cases of patients who developed tuberculosis at the site of a skin injury: three after being treated repeatedly with local corticosteroids via intramuscular injections, and two who cut themselves accidentally with a knife. All cultures yielded normal-sensitive Mycobacterium tuberculosis, and all patients responded well to anti-tuberculosis treatment. These unusual manifestations of non-respiratory tuberculosis may support the assumption that persistent, painful, reddish and/or fistulous areas of the skin might also indicate an infection caused by M. tuberculosis, via either reactivation of pulmonary tuberculosis or primary infection with M. tuberculosis by cutaneous transmission.

Antimicrobial treatment of fish tank granuloma.

Three patients with fish tank granuloma of the hand and forearm are reported. Each patient was treated with antimicrobial regimes which have rarely or never been previously used in this condition. Two patients responded well to treatment, one who received ciprofloxacin plus clarithromycin and another who was given clarithromycin plus ethambutol. The third patient received six different antimicrobial regimes before responding to a combination of rifabutin and ciprofloxacin. Our experience suggests that there now exist a number of effective alternatives to antimicrobials which have been traditionally used in the treatment of cutaneous Mycobacterium marinum infection.

Mycobacterium marinum disease in Anne Arundel County: 1995 update.

A retrospective survey of 41 cases of culture-positive Mycobacterium marinum disease in Anne Arundel County, Maryland, showed that most infection was related to recreational exposure to the Chesapeake Bay and its tributaries. Three quarters of cases consisted of skin or joint/tendon infection of the upper extremity, particularly the hand. An empiric drug regimen for a granulomatous soft tissue infection in this context should include rifampin and ethambutol or cotrimoxazole (trimethoprim/sulfamethoxazole). A reactive tuberculin skin test in Anne Arundel County is more likely to represent M. marinum infection than tuberculous infection.

[Anatomo-clinical forms of skin tuberculosis. (Dermatology service-Regional Hospital Center of Bouake, Ivory Coast)]. / Les formes anatomo-cliniques de la tuberculose cutanée. (Service de Dermatologie-Centre Hospitalier Régional de Bouaké-Côte d'Ivoire).

Tuberculosis of the skin is not exceptional in Africa South of the Sahara. The different ways of contamination of the skin by the tubercular bacillus and the level of immunologic reaction of the host account for the clinical polymorphisms. The bacillus is detected with difficulty, and the classical anatomo-pathological feature of tuberculoid granuloma is rarely complete: A classification based on physiopathological, clinical, bacteriological and histological criteria is an help to diagnosis.

Zoonotic dermatoses of dogs and cats.

Zoonotic dermatoses in dogs and cats are an important cause of skin disease in human beings. In addition, human dermatoses may occasionally be transmitted to dogs and cats. The veterinarian and the physician form a critical "health care team" in the proper management of these disorders.