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/patologíaRESUMEN
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.
Asunto(s)
Lupus Vulgar , Mycobacterium tuberculosis , Tuberculosis Cutánea , Humanos , Lupus Vulgar/diagnóstico , Lupus Vulgar/tratamiento farmacológico , Lupus Vulgar/patología , Tuberculosis Cutánea/diagnóstico , Granuloma , Prueba de TuberculinaRESUMEN
ABSTRACT The authors present a case of lupus miliaris disseminatus faciei , a rare skin disease of unknown etiology, which may cause unaesthetic scarring due to its difficult treatment. The histopathological examination of epithelioid granulomas with caseating necrosis, together with the clinical features, are important for diagnosis and early treatment with better results. Despite difficult and unsatisfactory treatment, there are ongoing studies on therapy to improve aesthetic and social impairment. This case report describes an initial misdiagnosis delaying appropriate treatment, and highlights the value of physical examination and clinical judgment for another pathological examination, whenever necessary, aiming at better treatment outcomes in daily practice.
RESUMO Os autores apresentam um caso de lupus miliaris disseminatus faciei , uma dermatose rara, de etiologia desconhecida, que pode deixar cicatrizes não estéticas, pela dificuldade de tratamento. O exame histopatológico de granulomas compostos por células epitelioides, com necrose caseosa, e as características clínicas, são importantes para o diagnóstico e tratamento precoce, com melhores resultados. Apesar do tratamento difícil e insatisfatório, há estudos em andamento sobre terapias para melhorar o comprometimento estético e social. Este relato de caso descreve um diagnóstico inicial errôneo, que atrasou o tratamento adequado, e destaca o valor do exame físico e raciocínio clínico para solicitar outro exame anatomopatológico, quando necessário, de forma a obter melhores desfechos com o tratamento, na prática diária.
Asunto(s)
Humanos , Femenino , Adulto , Enfermedades de los Párpados/patología , Enfermedades de los Párpados/tratamiento farmacológico , Dermatosis Facial/patología , Dermatosis Facial/tratamiento farmacológico , Tetraciclina/uso terapéutico , Prednisona/uso terapéutico , Isotretinoína/uso terapéutico , Cicatriz , Tacrolimus/uso terapéutico , Rosácea/patología , Rosácea/tratamiento farmacológico , Dapsona/uso terapéutico , Granuloma/patología , Granuloma/tratamiento farmacológico , Lupus Vulgar/patología , Lupus Vulgar/tratamiento farmacológico , Minociclina/uso terapéuticoRESUMEN
Cutaneous tuberculosis occurs in 1-2% of world cases of tuberculosis and more common in tropical countries. It presents with different clinical forms. Unusual clinical presentations are not uncommon and awareness of these will help in suspecting and managing these patients successfully. Lupus pernio like lupus vulgaris, tuberculosis of glans penis and lichen scrofulosorum on the distal parts of limbs are presented here because of their unusual clinical presentation.
Asunto(s)
Dermatosis Facial/patología , Dermatosis de la Pierna/patología , Lupus Vulgar/patología , Enfermedades del Pene/patología , Tuberculosis Cutánea/patología , Tuberculosis de los Genitales Masculinos/patología , Adulto , Antituberculosos/uso terapéutico , Dermatosis Facial/diagnóstico , Dermatosis Facial/tratamiento farmacológico , Antebrazo/patología , Humanos , Dermatosis de la Pierna/diagnóstico , Dermatosis de la Pierna/tratamiento farmacológico , Lupus Vulgar/diagnóstico , Lupus Vulgar/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Enfermedades del Pene/diagnóstico , Enfermedades del Pene/tratamiento farmacológico , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis de los Genitales Masculinos/diagnóstico , Tuberculosis de los Genitales Masculinos/tratamiento farmacológicoAsunto(s)
Antituberculosos/administración & dosificación , Lupus Vulgar/tratamiento farmacológico , Lupus Vulgar/patología , Enfermedades Cutáneas Papuloescamosas/patología , Biopsia con Aguja , Niño , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Lupus Vulgar/diagnóstico , Cuello , Medición de Riesgo , Índice de Severidad de la Enfermedad , Enfermedades Cutáneas Papuloescamosas/diagnóstico , Resultado del TratamientoAsunto(s)
Carcinoma de Células Escamosas/microbiología , Eritema/microbiología , Dermatosis de la Mano/microbiología , Lupus Vulgar/microbiología , Neoplasias Cutáneas/microbiología , Úlcera Cutánea/microbiología , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Diferenciación Celular , Eritema/patología , Eritema/cirugía , Femenino , Dermatosis de la Mano/patología , Dermatosis de la Mano/cirugía , Humanos , Lupus Vulgar/patología , Lupus Vulgar/cirugía , Persona de Mediana Edad , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Trasplante de Piel , Úlcera Cutánea/patología , Úlcera Cutánea/cirugía , Resultado del TratamientoRESUMEN
Lupus vulgaris, the commonest form of tuberculosis of the skin, presents with a plaque that enlarges slowly with advancing edges while showing atrophy at other areas. It may be acquired by the blood stream, via lymph, by contiguous spread or from external inoculation. We describe a case of lupus vulgaris with a large erythematous-scaly plaque of 44 × 26 cm over the back and a similar 7 × 5 cm plaque over the right thigh. The plaque over the back was gradually progressive for the previous ten years and showed scarring and atrophy at places. Histopathology of the area showed caseating granulomas with Langhans giant cells, epitheloid cells and lymphocytes. A diagnosis of lupus vulgaris was made. This case is being presented owing to the large size of the lesion.
Asunto(s)
Lupus Vulgar/patología , Diagnóstico Diferencial , Humanos , Lupus Vulgar/diagnóstico , Masculino , Persona de Mediana EdadAsunto(s)
Antituberculosos/uso terapéutico , Dermatitis/diagnóstico , Lupus Vulgar/diagnóstico , Mycobacterium tuberculosis/efectos de los fármacos , Anciano , Biopsia , Dermatitis/tratamiento farmacológico , Dermatitis/microbiología , Dermatitis/patología , Etambutol/uso terapéutico , Femenino , Humanos , Isoniazida/uso terapéutico , Lupus Vulgar/tratamiento farmacológico , Lupus Vulgar/microbiología , Lupus Vulgar/patología , Mycobacterium tuberculosis/crecimiento & desarrollo , Mycobacterium tuberculosis/patogenicidad , Nariz/microbiología , Nariz/patología , Rifampin/uso terapéutico , Resultado del TratamientoRESUMEN
Discoidlupus erythematosus (DLE) is a chronic type of cutaneous lupus erythematosus which can present in various morphologies, and the diagnosis can be rather confounding. Prompt evaluation and treatment is necessary to prevent disfigurement and systemic involvement associated with DLE. The following case presented a diagnostic dilemma as the lesion mimicked lupus vulgaris.
Asunto(s)
Lupus Eritematoso Cutáneo/complicaciones , Lupus Eritematoso Discoide/diagnóstico , Lupus Vulgar/diagnóstico , Piel/patología , Antirreumáticos/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Hidroxicloroquina/administración & dosificación , Hidroxicloroquina/uso terapéutico , Lupus Eritematoso Cutáneo/tratamiento farmacológico , Lupus Eritematoso Cutáneo/patología , Lupus Eritematoso Discoide/tratamiento farmacológico , Lupus Eritematoso Discoide/patología , Lupus Vulgar/patología , Esteroides/administración & dosificación , Esteroides/uso terapéutico , Resultado del Tratamiento , Adulto JovenAsunto(s)
Fémur , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/etiología , Lupus Vulgar/diagnóstico , Cicatrización de Heridas , Adulto , Biopsia , Enfermedad Crónica , Diagnóstico Diferencial , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Úlcera de la Pierna/patología , Lupus Vulgar/patología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Piel/patología , Tuberculosis Pleural/diagnósticoRESUMEN
BACKGROUND: Tuberculosis is a common problem in Turkey, and cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis. Herein, the authors describe a case of cutaneous tuberculosis (lupus vulgaris) occurring after contact with a sheep. CASE: A 15-year-old boy was admitted to Marmara University School of Medicine Pendik Training and Research Hospital (Istanbul, Turkey) with delayed wound healing on the left index finger and left axillary lymphadenopathy. His medical history was unremarkable except for a wound incurred when he slaughtered a sheep 3 months before. One month after this injury, the patient developed enlargement of the left axillary lymph node on the side of the wounded extremity, and the wound turned a dark black color. The biopsy specimens obtained from the wounded skin and lymph nodes showed granulomatous reaction, but acid-fast bacilli (AFB) could not be shown with Ehrlich-Ziehl Neelsen staining. The patient tested positive in an interferon-gamma release assay. Computerized tomography scans of the thorax were normal, and early morning gastric lavage specimen was negative for AFB. The wound and axillary lymphadenopathy disappeared after institution of anti-tuberculosis therapy. CONCLUSION: Tuberculosis infection must be considered in chronic skin lesions with granulomatous reaction occurring in countries with high prevalence of tuberculosis.
Asunto(s)
Antituberculosos/uso terapéutico , Axila/patología , Traumatismos de los Dedos/patología , Lupus Vulgar/diagnóstico , Linfadenopatía/patología , Mycobacterium tuberculosis/aislamiento & purificación , Enfermedades Profesionales/patología , Mataderos , Adolescente , Animales , Axila/microbiología , Etambutol , Traumatismos de los Dedos/tratamiento farmacológico , Traumatismos de los Dedos/microbiología , Humanos , Isoniazida , Lupus Vulgar/tratamiento farmacológico , Lupus Vulgar/patología , Linfadenopatía/tratamiento farmacológico , Linfadenopatía/microbiología , Masculino , Enfermedades Profesionales/tratamiento farmacológico , Enfermedades Profesionales/microbiología , Pirazinamida , Rifampin , Ovinos , Resultado del Tratamiento , Turquía , Cicatrización de HeridasRESUMEN
A 22-year-old male presented to the Dermatology Department with bilateral plaque lesions distributed symmetrically over malar area, bridge of nose and upper eyelids progressing over 1 year 3 months. Lesion remained unhealed after antibiotic treatment. Microscopy and culture for fungal and mycobacterial infections were negative. The Mantoux test showed an exaggerated response and PCR was positive for Mycobacterium tuberculosis complex. Patient was treated successfully with anti-tubercular therapy.