BCG and Kawasaki disease in Mexico and Japan.

Dr. Tomisaku Kawasaki was the first to describe BCG reactivation in Kawasaki Disease (KD), and this sign is present in about 30-50% of KD patients. It is a very specific early sign of the disease and although it has been recognized for decades, its pathophysiology continues to be an enigma. Recently, Yamada et al. reported a severe BCG reaction with tuberculid in 2 Japanese KD patients. We present 2 cases with KD and severe BCG reaction, one from Japan and the other from Mexico and review the policies of administration of BCG in both countries. The BCG vaccine has a worldwide coverage of 88%. Differences in BCG strains and methods of administration may influence BCG reactions in KD. The BCG reaction in the inoculation site may represent the most useful sign in KD.

Tubercúlide papulonecrótica: Caso clínico / Papulonecrotic tuberculid: Case report

Una niña de 12 años fue atendida por presentar pápulas milimétricas diseminadas que involucionaron hacia escaras varioliformes. La prueba de tuberculina fue fuertemente reactiva. Se diagnosticó una tuberculosis pulmonar subyacente y la paciente respondió al tratamiento antituberculoso. La tubercúlide papulonecrótica es una erupción cutánea que se cree debida a hipersensibilidad ante un foco subyacente de tuberculosis y sería un indicador de buen estado inmunitario.(AU)

A 12-year-old girl was seen with widespread millimetric papules which resolved leaving varioliform scars. Tuberculin test was strongly reactive. Underlying pulmonary tuberculosis was diagnosed. The patient responded to antituberculous treatment. Papulonecrotic tuberculid is a skin eruption thought to be due to hypersensitivity to an underlying focus of tuberculosis and is an indicator of good immunologic status.(AU)

Tubercúlide papulonecrótica: Caso clínico / Papulonecrotic tuberculid: Case report

Una niña de 12 años fue atendida por presentar pápulas milimétricas diseminadas que involucionaron hacia escaras varioliformes. La prueba de tuberculina fue fuertemente reactiva. Se diagnosticó una tuberculosis pulmonar subyacente y la paciente respondió al tratamiento antituberculoso. La tubercúlide papulonecrótica es una erupción cutánea que se cree debida a hipersensibilidad ante un foco subyacente de tuberculosis y sería un indicador de buen estado inmunitario.

A 12-year-old girl was seen with widespread millimetric papules which resolved leaving varioliform scars. Tuberculin test was strongly reactive. Underlying pulmonary tuberculosis was diagnosed. The patient responded to antituberculous treatment. Papulonecrotic tuberculid is a skin eruption thought to be due to hypersensitivity to an underlying focus of tuberculosis and is an indicator of good immunologic status.

Recurrent nodules in the calves: A sign of tuberculosis / Recurrent nodules in the calves: A sign of tuberculosis

Aims: To describe a case of erythema induratum of Bazin, classified as a tuberculid, or skin lesion with similar histological features to true cutaneous tuberculosis, in which the relation with Mycobacterium tuberculosis cannot be easily demonstrated.Case Description: A 60-year-old woman presented with recurrent multiple nodules in the legs. Skin examination revealed violaceous painless nodules, some of them ulcerated, with a serous fluid, located on both legs in an asymmetric way, predominantly in the calves. Lesions disappeared spontaneously for brief periods. Skin biopsies revealed septal and lobular panniculitis with epithelioid granulomata and vascular necrosis. Tuberculin skin test was positive. Culture of the cutaneous lesions and polymerase chain reaction to Mycobacterium tuberculosis were negative, but mediastinal lymph nodes collected through mediastinoscopy were cultivated and positive to Mycobacterium tuberculosis. Therapy with isoniazid, rifampicin, pyrazinamide and ethambutol were administered. After two months under therapy the skin lesions healed. The clinical and histopathological features and the strong positive tuberculin skin test have strongly suggested the diagnosis of erythema induratum of Bazin. Positive culture for Mycobacterium tuberculosis and the remission of the lesions with antituberculosis therapy confirmed the diagnosis.Conclusions: Clinicians must be aware of the differential diagnosis of recurrent skin lesions, including the erythema induratum of Bazin. In this case, association with tuberculosis was confirmed by positive culture of mediastinal lymph nodes for Mycobacterium tuberculosis and remission of the lesions with antituberculosis therapy.

Objetivos: descrever um caso de eritema induratum de Bazin, classificado como tubercúlide, lesão cutânea com características histológicas semelhantes à tuberculose cutânea, mas na qual a relação entre o Mycobacterium tuberculosis não é facilmente demonstrada.Descrição do Caso: uma mulher de 60 anos de idade apresentou-se com múltiplos nódulos recorrentes nos membros inferiores. O exame da pele revelou nódulos indolores, violáceos, alguns deles ulcerados, com um líquido seroso, localizados em ambas as pernas, de forma assimétrica e com predomínio nas panturrilhas. As lesões apresentavam um aparecimento paroxístico, com remissão espontânea por breves períodos. Foi realizada biópsia cutânea que revelou paniculite septal e lobular com granulomas epitelióides e necrose vascular. O teste tuberculínico foi positivo. A cultura das lesões cutâneas e a reação em cadeia da polimerase para Mycobacterium tuberculosis foram negativos, mas foi realizada biópsia de linfonodos por mediastinoscopia, cuja cultura foi positiva para Mycobacterium tuberculosis. Foi iniciada terapêutica específica com isoniazida, rifampicina, pirazinamida e etambutol. Após dois meses de tratamento houve remissão das lesões. As características clínicas e histopatológicas e o teste tuberculínico fortemente positivo sugeriram o diagnóstico de eritema indurado de Bazin, sendo este confirmado pela cultura de linfonodos positiva para Mycobacterium tuberculosis e pela remissão das lesões com a terapêutica antituberculose.Conclusões: o clínico precisa estar atento para o diagnóstico diferencial de lesões cutâneas recorrentes, incluindo neste o eritema induratum de Bazin. Neste caso, a associação com a tuberculose ficou confirmada pela cultura dos linfonodos mediastinais positiva para Mycobacterium tuberculosis e remissão das lesões com a terapêutica antituberculose.

Nuevo espectro de tuberculide papulosa: aspectos clínicos e histopatológicos a propósito de un caso / New spectrum of papular tuberculid: clinical and pathological aspects due to a case

Presentamos el caso de un paciente varón de 59 años de edad quien inicialmente presentó un cuadro clínico de tuberculide papulosa en rostro o tuberculide rosaceiforme, que progresivamente se extiende a cuero cabelludo, cuello, tronco y miembros superiores. Se plantea la posibilidad de que este nuevo espectro de tuberculides constituiría formas de tuberculosis cutánea paucibacilar.

We present the case of a 59-years-old male patient who was diagnosed of papular tuberculid or rosaceiform tuberculid in face, with progressive extension to the scalp, neck, trunk and arms. We propose that this new spectrum of tuberculids could be a paucibacilar form of cutaneous tuberculosis.