RESUMEN
Tuberculous gumma (TG) is a rare type of cutaneous tuberculosis thought to occur as a result of the hematogenous spread of Mycobacterium tuberculosis, which is more common in immunosuppressed individuals. An 8-year-old boy presented with a 2-month history of multiple indolent enlarging ulcerated nodules on his left upper extremity. He had a past medical history of bacille Calmette-Guerin vaccine induced lupus vulgaris. Skin biopsy of the nodules showed granulomas and neutrophil-dominated purulent inflammation. Ziehl-Neelsen staining was negative, and the cultures were positive for M. tuberculosis. Furthermore, the M. tuberculosis complex was identified using metagenomic next-generation sequencing. Standard antitubercular therapy was started at full doses, and the skin lesions had significantly improved 3 months later. Here we review the literature since 2000 and describe the clinical and pathological features of TG.
Asunto(s)
Lupus Vulgar , Mycobacterium tuberculosis , Tuberculosis Cutánea , Masculino , Humanos , Niño , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Lupus Vulgar/patología , Antituberculosos/uso terapéutico , Piel/patologíaAsunto(s)
Vacuna BCG , Lupus Vulgar , Factor de Transcripción STAT1 , Humanos , Vacuna BCG/efectos adversos , Vacuna BCG/administración & dosificación , Factor de Transcripción STAT1/genética , Lupus Vulgar/diagnóstico , Lupus Vulgar/genética , Lupus Vulgar/tratamiento farmacológico , Lupus Vulgar/inmunología , Predisposición Genética a la Enfermedad , Masculino , Mycobacterium bovis/aislamiento & purificación , Mycobacterium bovis/inmunología , FemeninoRESUMEN
@#Cutaneous tuberculosis, a rare dermatologic condition with a wide spectrum of clinical findings depending on the source and immune status of patient. The common subtype is Lupus Vulgaris which is extremely chronic and progressive type
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Manejo de Caso , Lupus Vulgar , TuberculosisRESUMEN
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.
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Lupus Vulgar , Mycobacterium tuberculosis , Tuberculosis Cutánea , Humanos , Lupus Vulgar/diagnóstico , Lupus Vulgar/tratamiento farmacológico , Lupus Vulgar/patología , Tuberculosis Cutánea/diagnóstico , Granuloma , Prueba de TuberculinaAsunto(s)
Dermatosis Facial , Hiperpigmentación , Lupus Vulgar , Rosácea , Humanos , Minociclina/efectos adversos , Rosácea/inducido químicamente , Rosácea/diagnóstico , Rosácea/tratamiento farmacológico , Hiperpigmentación/inducido químicamente , Hiperpigmentación/diagnóstico , Dermatosis Facial/inducido químicamente , Dermatosis Facial/diagnóstico , Dermatosis Facial/tratamiento farmacológicoRESUMEN
Tuberculosis continues to be a major public health concern worldwide with almost 20-40% of the world's population being affected yearly. Cutaneous Tuberculosis (TB) is a rare and underdiagnosed entity that manifests in about 1-1.5% of extrapulmonary tuberculosis cases worldwide. Dermoscopy is a non-invasive tool which will be a useful aid to histopathology in the confirmation of the diagnosis alongside culture, and molecular techniques. This is a cross-sectional descriptive study that was conducted at a tertiary care center in Mumbai, India. A total of 31 patients were enrolled in this study; 14 males and 17 females. The mean duration of disease was 4.3 months and the average age was 31 years. There were 10 cases of lupus vulgaris, 7 scrofuloderma, 5 papulonecrotic tuberculid (PNT), 3 tuberculosis verrucosa cutis (TBVC), and 2 cases each of erythema induratum of Bazin, lichen scrofulosorum and resolved lupus vulgaris. All the lesions demonstrated orange yellow background suggestive of dermal granuloma. Other key dermoscopic features noted include yellowish-white scales, patulous follicles, white structureless areas, milia-like cysts, white streaks, pigment globules, hairpin and linear vessels. Newer findings such as the crown of vessels and perifollicular pallor in lichen scrofulosorum, and radiating white streaks in PNT were also noted. Dermoscopy of infective granulomas such as cutaneous tuberculosis is a less explored field of dermatology. Newer dermoscopic features of each clinical variant of cutaneous TB have been described.
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Lupus Vulgar , Tuberculosis Cutánea , Masculino , Femenino , Humanos , Adulto , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/patología , Estudios Transversales , India/epidemiologíaRESUMEN
Primary cutaneous large B cell lymphoma, leg type is a rare and aggressive variant of cutaneous B cell lymphoma. It predominantly affects elderly women, with the lower limb being the most common site of presentation. The overall prognosis is poor, compared to other cutaneous B cell lymphomas. A 47-year-old man presented with a progressively enlarging nodule over the medial aspect of the left foot since 2 months. Clinical examination revealed a nodular plaque-like lesion with central ulceration that measured 7 × 7 cm, firm in consistency, and with ill-defined margins. The initial clinical diagnosis was lupus vulgaris. An incision biopsy was done, which on histopathology and immunohistochemistry revealed a rare diagnosis of primary cutaneous B cell lymphoma, leg type. The patient was started on chemotherapy; however, he succumbed to his illness about 1 year after the initial presentation. It is a rare type of cutaneous lymphoma, which may masquerade infectious disorders such as lupus vulgaris. A detailed histopathological and immunohistochemical analysis is essential for its correct diagnosis and management. Only a handful of cases of this rare condition are reported to date. This case has been reported in view of its rarity and unusual clinical presentation.
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Lupus Vulgar , Linfoma de Células B , Linfoma de Células B Grandes Difuso , Neoplasias Cutáneas , Masculino , Humanos , Femenino , Anciano , Persona de Mediana Edad , Pronóstico , Biopsia , Extremidad Inferior/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/patologíaRESUMEN
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Personas con Discapacidad , Consejos de Salud , Capacitación de Recursos Humanos en Salud , Integralidad en Salud , Enfermedades Reumáticas/prevención & control , Lupus Vulgar/prevención & control , Agentes Inmunomoduladores/uso terapéutico , Suicidio/estadística & datos numéricos , Salud Laboral , Enfermedades Profesionales/psicología , Vigilancia de la Salud del Trabajador , Brasil/epidemiologíaRESUMEN
Cutaneous tuberculosis is a rare type of extrapulmonary tuberculosis and it is uncommon even in places where tuberculosis is widespread. A 32-year-old female presented with fever and headache along with prior history of an ulcer in her leg which was treated as cellulitis at another centre. The neck rigidity, and the Kernig and Budzinski sign were also positive. There were also features of increased intracranial pressure. The non-contrast computed tomography showed bilateral hydrocephalus and hypodense areas. She was managed for increased intracranial pressure and anti-tubercular therapy for disseminated tuberculosis. Biopsy of non-healing wounds should be checked for lupus vulgaris. Keywords: case reports; lupus vulgaris; meningitis; skin; tuberculosis.
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Lupus Vulgar , Tuberculosis Cutánea , Tuberculosis Meníngea , Femenino , Humanos , Adulto , Lupus Vulgar/diagnóstico , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis Cutánea/patología , Piel/patología , BiopsiaAsunto(s)
Lupus Vulgar , Mycobacterium bovis , Humanos , Lupus Vulgar/diagnóstico , Lupus Vulgar/microbiologíaRESUMEN
Cutaneous tuberculosis represents the fifth extrapulmonary form in Morocco after pleural, lymph node, urogenital, and intestinal tuberculosis. It is recognized to form a continuous immunopathologic spectrum, ranging from a high intensity to a low intensity of cell-mediated immunity, which explains the multiplicity and heterogeneity of anatomo-clinical forms. Association of multiple forms in the same patient is really rare. In this regard, we report a case of scrofuloderma on axillary tuberculosis adenitis associated to a lupus vulgaris in an immunocompetent patient, which was confirmed by histology, QuantiFERON-TB Gold test, and polymerase chain reaction. He received an antituberculous therapy with clinical regression of the lesions. In conclusion, cutaneous tuberculosis is still endemic in developing countries.The diagnosis is difficult because of its clinical polymorphism. That's why it's should be suspected clinically in the presence of any destructive or verrucous skin lesion evolving without healing for a long period and confirmed by bacteriological examinations and histology.
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Lupus Vulgar , Peritonitis Tuberculosa , Tuberculosis Cutánea , Tuberculosis Gastrointestinal , Tuberculosis Ganglionar , Masculino , Humanos , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis Cutánea/complicaciones , Lupus Vulgar/diagnóstico , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/tratamiento farmacológico , Tuberculosis Ganglionar/complicaciones , Peritonitis Tuberculosa/complicacionesRESUMEN
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.
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Lupus Vulgar , Mycobacterium tuberculosis , Tuberculosis Cutánea , Humanos , Niño , Tuberculosis Cutánea/complicaciones , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Lupus Vulgar/diagnóstico , Lupus Vulgar/tratamiento farmacológicoRESUMEN
@#Digital gangrene is an uncommon initial manifestation of systemic lupus erythematosus (SLE) and rarely in late-onset disease. This case presents a 50-year-old woman who developed digital gangrene and was subsequently diagnosed with SLE. Early treatment with immunosuppression and anticoagulation halted the progression of the digital ischemia. This case highlights that late-onset SLE, often described as having a more benign and insidious course, can also present with catastrophic limb-threatening manifestations.
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Lupus VulgarRESUMEN
TAFRO syndrome is a very rare disease, with less than 100 cases reported in the literature. It is classified as a type of idiopathic multicentric Castleman disease, but it has clinical, paraclinical, and histopathological characteristics that differentiate between TAFRO and idiopathic forms of Castleman disease not otherwise specified. However, it is a challenging exclusion diagnosis. TAFRO syndrome is characterized by systemic inflammatory involvement, often severe, which can present with kidney failure, and become a severe disease with a high mortality rate. The clinical manifestations of TAFRO can be confused with hematology malignancies or various autoimmune diseases. Although there are some reports of TAFRO syndrome associated with autoimmune compromise, there is no published consensus for the diagnosis or treatment. The case presented is a patient who meets the criteria to be classified as SLE, and with manifestations with significant clinical involvement, but with no improvement with standard treatment. It was found that the patient's systemic involvement was due to TAFRO, and that therefore the TAFRO syndrome could simulate SLE, something previously not described in the literature.
El síndrome TAFRO es una enfermedad muy poco común, con menos de 100 casos reportados en la literatura. Se clasifica como un tipo de enfermedad de Castleman multicéntrica idiopática, pero tiene características clínicas, paraclínicas e histopatológicas que permiten diferenciarla de las formas de la enfermedad Castleman idiopática no clasificadas de otra manera; sin embargo, es un diagnóstico de exclusión difícil de hacer. El síndrome TAFRO se caracteriza por compromiso inflamatorio sistémico, en muchas ocasiones severo, que puede presentarse con falla renal y convertirse en una enfermedad grave, con una alta tasa de mortalidad. Las manifestaciones clínicas de TAFRO pueden confundirse con neoplasias hematológicas o varias enfermedades autoinmunes. En la literatura existen algunos reportes de síndrome TAFRO asociados con compromiso autoinmune, pero no se ha publicado un consenso para su diagnóstico ni para su tratamiento. El caso que se presenta es un paciente que cumple con los criterios para ser clasificado como LES, que tenía manifestaciones con gran compromiso clínico, pero sin mejoría con el tratamiento estándar. Se encontró que el compromiso sistémico del paciente era por TAFRO y que, por lo tanto, el síndrome TAFRO podría simular LES, algo no descrito previamente en la literatura.