Disseminated cutaneous tuberculosis from BCG vaccination site in an immunocompetent child.

A healthy 4-month-old girl presented with widespread scaly papules and a nodule over the site of BCG immunization. A diagnosis of disseminated cutaneous tuberculosis in an immunocompetent child was confirmed with biopsy. The child was treated with antituberculosis therapy without recurrence.

Two Cases of Subcutaneous Tuberculous Granuloma Associated with BCG Vaccination.

In recent years, BCG vaccination is routinely performed worldwide. The Ministry of Health, Labor and Welfare of Japan reported that the vaccination rate was as high as 92.9% in 2011. Majority of the reported local adverse reactions to BCG vaccination included lymph node swelling, keloid formation, and abscesses. Subcutaneous tuberculous granuloma is a rare local adverse reaction to BCG vaccination. Herein, we report two cases of developing subcutaneous tuberculous granuloma associated with BCG vaccination. Both of them were treated with isoniazid. There is no standard management for BCG-induced subcutaneous tuberculous granuloma, however, treatment with anti-tuberculosis drugs should be considered for cases of BCGinduced subcutaneous tuberculous granuloma with abscesses or ulcerations.

A case report of mucocutaneous tuberculosis after orthotopic liver transplantation: a challenging diagnosis.

BACKGROUND: Mycobacterium tuberculosis is responsible for high morbidity and mortality in immune-compromised hosts. CASE PRESENTATION: We present a rare case of cutaneous tuberculosis after orthotopic liver transplantation without involvement of any other organs. CONCLUSION: TB risk-factors assessment, careful LTBI screening and treatment according to national guidelines, as well as a reduction in missed opportunity for prevention are necessary to avoid MTB related disease in fragile patients.

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.

Mycobacterium fortuitum infection of the scalp after a skin graft.

Mycobacterium fortuitum is a non-tuberculous mycobacterium found in the soil and water of most regions of the world, and it can cause disease in immunocompetent and immunocompromised hosts. We present a 52-year-old man who developed a scalp abscess under a free flap for cranium coverage after a motor vehicle accident. Culture of material drained from the abscess grew M. fortuitum.

A rare case of primary inoculation tuberculosis seen after varicella.

Primary inoculation tuberculosis (TB) is a rare form of cutaneous TB resulting from direct introduction of Mycobacterium tuberculosis into the skin or mucosa of a previously uninfected, nonimmune person. We herein report the first case, to our knowledge, of primary inoculation TB to be seen after varicella; this case explains the possible mechanism of varicella-zoster virus-mediated transient cellular immune suppression that predisposed the patient to cutaneous TB. In this case, we believe that varicella-zoster virus (VZV) infection predisposed the patient to primary inoculation TB by leading to direct inoculation of tuberculosis bacilli through vesicles or by suppressing cellular immunity.

Disseminated cutaneous BCG infection following BCG immunotherapy in patients with lepromatous leprosy.

Cutaneous complications of Bacillus Calmette-Guerin (BCG) vaccine, especially in the form of generalised disease, are uncommon and mostly occur in immunocompromised individuals. There is a paucity of data on the cutaneous adverse reactions secondary to BCG immunotherapy in leprosy. We report two unique cases of disseminated cutaneous BCG infection following immunotherapy in patients with lepromatous leprosy. To our knowledge, cutaneous BCG infection presenting as widespread lesions after immunotherapy and confirmed by isolation of Mycobacterium bovis by polymerase chain reaction (PCR) has not been described. A high index of suspicion is required when leprosy patients who receive BCG immunotherapy develop new lesions that cannot be classified as either reaction or relapse, and diagnosis may be confirmed on histopathology and PCR.

When a respiratory pathogen turns to the skin: cutaneous tuberculosis in a lung transplant patient.

A 62-year-old male, who received immune suppressive therapy due to a lung transplantation several years ago, developed multiple painful abscesses in the right forearm. First misdiagnosed as staphylococcal abscesses, Mycobacterium tuberculosis was eventually cultured from the abscesses. In addition, the patient also suffered from pulmonary tuberculosis and respiratory specimens were also culture-positive for Mycobacterium tuberculosis. Cutaneous tuberculosis must be kept as a differential diagnosis in the case of abscess-like lesions on the skin, especially in immunocompromised patients. Mycobacteria specific tests (polymerase chain reaction in respiratory samples and wound smears) and antituberculotic combination therapy are necessary to treat Mycobacterium tuberculosis infection/reactivation adequately.

Update on cutaneous tuberculosis

Tuberculosis continues to draw special attention from health care professionals and society in general. Cutaneous tuberculosis is an infection caused by M. tuberculosis complex, M. bovis and bacillus Calmette-Guérin. Depending on individual immunity, environmental factors and the type of inoculum, it may present varied clinical and evolutionary aspects. Patients with HIV and those using immunobiological drugs are more prone to infection, which is a great concern in centers where the disease is considered endemic. This paper aims to review the current situation of cutaneous tuberculosis in light of this new scenario, highlighting the emergence of new and more specific methods of diagnosis, and the molecular and cellular mechanisms that regulate the parasite-host interaction.

Update on cutaneous tuberculosis.

Tuberculosis continues to draw special attention from health care professionals and society in general. Cutaneous tuberculosis is an infection caused by M. tuberculosis complex, M. bovis and bacillus Calmette-Guérin. Depending on individual immunity, environmental factors and the type of inoculum, it may present varied clinical and evolutionary aspects. Patients with HIV and those using immunobiological drugs are more prone to infection, which is a great concern in centers where the disease is considered endemic. This paper aims to review the current situation of cutaneous tuberculosis in light of this new scenario, highlighting the emergence of new and more specific methods of diagnosis, and the molecular and cellular mechanisms that regulate the parasite-host interaction.

Analysis of 30 patients with acupuncture-induced primary inoculation tuberculosis.

Primary inoculation tuberculosis is a skin condition that develops at the site of inoculation of Mycobacterium tuberculosis in tuberculosis-free individuals. This report describes the diagnosis, treatment and >1 year follow-up of 30 patients presenting with acupuncture-induced primary inoculation tuberculosis. Our data provide a deeper insight into this rare route of infection of tuberculosis. We also review effective treatment options.

Isolated cold abscess of the thigh in an immunocompetent infant.

Isolated cold abscess of the thigh without active tuberculosis elsewhere in the body is a rare entity, and only a few cases have been reported in the literature. We report a case of isolated cold abscess of the thigh following DPT vaccination in an immunocompetent child. The association with DPT vaccination is intriguing and requires further research.

Tuberculosis cutánea: presentación de cuatro formas clínicas / Cutaneous tuberculosis: presentation of four clinical forms

La tuberculosis cutánea es una enfermedad infecciosa crónica causada por el Mycobacterium tuberculosis. Se presenta en una variedad de formas clínicas que dependen de la vía de llegada del bacilo a la piel y del estado inmunológico del paciente. La reacción en cadena de la polimerasa (RCP) ha permitido enrolar en el grupo de la tuberculosis cutánea a entidades antes reconocidas como tuberculides. Sin embargo, en muchos casos, la RCP no está disponible en países en desarrollo, en los cuales la incidencia considerable presenta a la tuberculosis como un problema de salud pública. Se presenta cuatro pacientes con formas clínicas distintas de tuberculosis cutánea (tuberculide papulonecrótica, escrofuloderma, tuberculosis verrucosa cutis y eritema indurado de Bazin), que reciben tratamiento antituberculoso de acuerdo al esquema nacional de tratamiento con evolución favorable.

Cutaneous tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. lt comes in a variety of clinical forms depending on the route of arrival of the bacillus to the skin and the immune status of the patient. The polymerase chain reaction (PCR) has allowed enrolling in group TB skin entities before recognized as tuberculids; however often not available in developing countries in which the considerable incidence that tuberculosis has, it becomes a problem public health. We report 4 patients with different clinical forms of cutaneous tuberculosis (tuberculid papulonecrotic, scrofuloderma, tuberculosis verrucosa cutis and indurated erythema Bazin) receiving tuberculosis treatment according to national treatment regimen with a favorable evolution.