Multiple subcutaneous tuberculous abscesses in a dermatomyositis patient without pulmonary tuberculosis: a case report and literature review.

BACKGROUND: Even though remarkable progress for diagnostics of pulmonary TB has been made, it is still a challenge to establish a definitive diagnosis for extrapulmonary TB (EPTB) in clinical practice. Among all the presentations of EPTB, cold abscesses are unusual and deceptive, which are often reported in the chest wall and spine. Subcutaneous abscess in the connective tissue of limbs is extremely rare. CASE PRESENTATION: A 48-year-old man with dermatomyositis was hospitalized because of multiple subcutaneous tuberculous abscesses in his limbs, but without pulmonary tuberculosis. Particularly, one insidious abscess appeared during anti-TB treatment due to "paradoxical reaction". After routine anti-TB therapy, local puncture drainage and surgical resection, the patient was cured and discharged. CONCLUSIONS: Tuberculous infection should be kept in mind for the subcutaneous abscess of immunocompromised patients, even without previous TB history. Treatment strategy depends on the suppurating progress of abscess lesions. Meanwhile, complication of newly-developed insidious abscess during treatment should be vigilant.

Tuberculous gummas: Epidemiological, clinical, bacteriological, immunological, and therapeutic features.

Tuberculous gummas are an unusual form of tuberculosis (TB) accounting for 1%-2% of all cutaneous TB cases. The aim of this article was to describe the epidemiological, clinical, bacteriological, immunological, and therapeutic features of this form upon a case report and a literature review. Forty-eight case reports were identified through a PubMed and Google Scholar search using the following keywords: "tuberculous gumma" and "metastatic tuberculous abscesse." Tuberculous gumma can occur at any age. Immunodepression is not a sine qua non condition to the development of the disease. Limbs are the most frequent site for gummas. Tuberculous gummas are associated to another location in only 73% of cases. The most frequent associated locations are lung, nodes, and musculoskeletal apparatus. Mantoux test is negative in 38% of cases. Skin stain is positive in 45% of cases and culture in 85% of cases. Giant epithelioid cell granuloma is present in 82.4% of cases. There is no universally accepted chemotherapy regimen for metastatic tuberculous abscesses. The classic 2RHZE/4RH is highly effective.

TBC cutánea causada por Mycobacterium tuberculosis multidrogo resistente: reporte de un caso / Cutaneous TBC caused by multi-drug resistant Mycobacterium tuberculosis. case report

La TBC es una enfermedad causada por Mycobacterium tuberculosis y afecta usualmente el pulmón aunque un pequeño porcentaje se puede presentar en la forma cutánea. Se presenta el caso de un varón de 23 años, natural de la provincia de Madre de Dios, que desarrolló TBC pulmonar y cutánea causado por Mycobacterium tuberculosis MDR. El diagnóstico se hizo por Bk de secreción cutánea y Bk de esputo con resultado positivo en ambos casos; presentó además edema en hemicuerpo izquierdo, y ulceras a nivel esternal y a nivel clavicular. El paciente fue hospitalizado como enfermedad TBC pulmonar y extrapulmonar. El caso reportado pone en énfasis la TBC cutánea y el riesgo que esto significa aun en pacientes inmunocompetentes.

TBC caused by Mycobacterium tuberculosis and affects usually the lung, although a small percentage of patients present with skin involvement. We present the case of a 23-year-old male patient from Madre de Dios who developed both pulmonary and skin TBC caused by multi-drug resistant Mycobacterium tuberculosis. The diagnosis was made by detecting Mycobacterium using acid fast stains in sputum and skin samples. This case illustrates the risk that immunosuppressed patients has to get cutaneous tuberculosis.

Tropical Skin Diseases in Children: A Review-Part II.

Tropical skin diseases are infectious conditions influenced by factors such as nutrition, housing, and the environment. Migration patterns have caused these conditions to be seen all around the world, not only in developing countries. Many of these diseases have a different presentation in childhood, which changes the diagnostic approach and management options. In this article, we review some of the most common tropical mycobacterial, protozoan, parasitic, and viral dermatologic conditions in children, including their epidemiologic, clinical, diagnostic, and therapeutic aspects.

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.

Clinicopathologic spectrum of cutaneous tuberculosis: a retrospective analysis of 165 Indians.

BACKGROUND: Although cutaneous tuberculosis (CTB) is well described, it is wise to periodically revisit the prevailing clinical and epidemiological features, of this somewhat uncommon entity in developed nations that is also usually neglected in national tuberculosis control programs in countries where tuberculosis is a major health problem, to maintain heightened awareness as the HIV pandemic runs its course. METHODS: Medical records of 165 cases of CTB, diagnosed from 2007 to 2010, were studied. The diagnosis in each was made on the basis of well-conceived and described criteria. All patients had earlier been immunized with Bacillus Calmette-Guérin soon after birth. Patients were evaluated by routine hematology, Mantoux test, screening for HIV status in addition to fine-needle aspiration cytology, and/or histopathology of the lesion. RESULTS: Of the 165 cases (94 males and 71 females, male:female ratio of 1.32:1; age range, 1-64), 85 were lupus vulgaris, 11 tuberculosis verrucosa cutis (paucibacillary), and 39 scrofuloderma (multibacillary). The remaining 17 were tuberculids comprising 24 lichen scrofulosorum, 3 papulonecrotic tuberculid, 2 erythema induratum, and 1 erythema nodosum, afflicting children and young adults (age range, 0-10; 21-30). Fine-needle aspiration cytology was diagnostic in 39 cases, histopathology in 117, and their combination in 9. Clinicopathologic correlation and response to antituberculosis treatment were additional diagnostic adjuncts. CONCLUSIONS: CTB has a varied clinical and morphological spectrum. Cytology and histopathology play a key role in its diagnosis. An additional adjunct is the clinical response to antituberculosis treatment.

Tuberculosis cutánea: revisión del tema a propósito de dos casos / Cutaneous tuberculosis: two cases and literature review

La Tuberculosis Cutánea es una enfermedad infecciosa crónica causada por el Mycobacterium tuberculosis. Pese a ser una forma poco frecuente de presentación de la Tuberculosis, representa un gran desafío para los clínicos que se enfrentan a estos casos, debido principalmente a la gran diversidad de formas clínicas existentes. A continuación presentamos 2 casos clínicos de Tuberculosis Cutánea diagnosticados en el Hospital Regional de Talca y una revisión del tema basada en la clasificación, diagnóstico y tratamiento de la enfermedad.

Cutaneous Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. Despite being a rare presentation of the disease, Cutaneous Tuberculosis is a major challenge for clinicians who face these cases, mainly due to the great diversity of clinical forms. We present 2 cases of Cutaneous Tuberculosis diagnosed in Hospital Regional de Talca and a review of the topic based in classification, diagnosis and treatment of the disease.

Tropical and exotic dermatoses and ulcers.

BACKGROUND: Tropical dermatoses and ulcers, although essentially unique to tropical and subtropical areas, are occasionally seen in Australian general practice on returning travellers and migrants from endemic countries. OBJECTIVE: This article will discuss important causes of tropical and exotic ulcers occasionally seen in Australia. DISCUSSION: As tropical ulcers may mimic many other causes of skin ulceration and nodules, a history of recent travel should arouse clinical suspicion. The time frame since exposure to the causative organism is an important feature in the diagnostic process. For example, pyodermas and cutaneous larva migrans present a few days after contact with the causative agents, whereas leishmaniasis, cutaneous tuberculosis, atypical mycobacterial diseases (swimming pool granulomas) and tropical mycosis take weeks to months to appear.

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.

[Cutaneous manifestation of tuberculosis causing impaired healing after minor injury]. / Kutane Tuberkulosemanifestation als Ursache einer Wundheilungsstörung nach Bagatelltrauma.

HISTORY AND CLINICAL FINDINGS: After a trivial injury, a male patient from India presented with a non-healing minor injury. A necrotic lesion at the right medial ankle was evident. EXAMINATIONS: Mycobacterium tuberculosis complex was detected from tissue material both in cultures and by molecular markers. Sonography of the abdomen indicated a retroperitoneal abcess formation. DIAGNOSIS, TREATMENT AND COURSE: Cutaneous tuberculosis with involvement of the spine and an abscess of the psoas muscle was diagnosed. After initiation of antituberculotic treatment elevation of liver enzymes was noted. The initially observed skin lesion in the area of the right ankle healed quickly; however, the abscess of the psoas muscle did not. The abscess was drained by puncture. During follow up no fistula formation was observed. CONCLUSION: Tuberculosis should be considered as differential diagnosis in cases of poorly healing skin lesions caused by trauma, especially in patients from tuberculosis high incidence regions.

Tuberculosis verrugosa: reporte de un caso / Warty tuberculosis: case report

La tuberculosis verrugosa es una enfermedad infecciosa crónica producida por Mycobacterium tuberculosis. Actualmente se ve un incremento de la tuberculosis por la resistencia del bacilo a los fármacos y por el virus de la inmunodeficiencia adquirida. Presenta una gran variedad clínica y es un reto diagnóstico. Se presenta un caso con buena evolución con el tratamiento antituberculoso.

The warty tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. Is now increased by the tuberculosis bacillus resistance to drugs and for the acquired immunodeficiency virus. Presents a clinical variety and is a diagnostic challenge. A case is presented with its good performance with tuberculosis treatment.

Granulomatous skin lesions, severe scrotal and lower limb edema due to mycobacterial infections in a child with complete IFN-γ receptor-1 deficiency.

Interferon-γ receptor-1 (IFNγR1) deficiency is caused by mutations in the IFNγR1 gene and is characterized mainly by susceptibility to mycobacterial disease. Herein, we report an 8-month-old boy with complete recessive IFNγR1 deficiency, afflicted by recurrent mycobacterial diseases with Mycobacterium bovis, Mycobacterium tuberculosis, Mycobacterium avium intracellulare and Mycobacterium fortuitum. Genetic analysis showed a homozygous mutation (106insT) in the IFNγR1 gene leading to complete IFNγR1 deficiency. In addition, he had atypical mycobacterial skin lesions caused by M. avium intracellulare and developed scrotal and lower limb lymphedema secondary to compression of large and fixed inguinal lymphadenopathies. Hematopoietic stem cell transplantation was performed from a matched unrelated donor at 5 years of age; however, he died at 9 months post-transplant. To our knowledge, the patient is the first case with IL-12/IFN-γ pathway defect and severe lymphedema. We have also reviewed and summarized the literature related with IFNγR1 deficiency.

Scrofuloderma--a case series from rural India.

Cutaneous tuberculosis is the rarest presentation of all the forms of tuberculosis. Scrofuloderma is a frequent manifestation of cutaneous tuberculosis in Indian scenario. Males are affected one and half times more than females. The most common affected age group showing clinical infection is within the first three decades of life. A series of cases mostly malnourished children attending a tertiary care centre in a rural area of central India is being reported. They have presented with a wide spectrum of clinical features, forcing us to establish the final diagnosis by Mantoux test, fine needle aspiration cytology and histopathological examination. The mainstay of treatment remains medical therapy but the underlying cause for severe immunosuppression needs to be ruled out and treated.

Tuberculosis colicuativa / Colliquative cutaneous tuberculosis

La Tuberculosis cutánea es una enfermedad infecciosa crónica causada por 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 huésped; la mayoría procede de fuente endógena. LaTuberculosis es una enfermedad de alta prevalencia en países en vías de desarrollo como el nuestro, siendo las formas cutáneas cerca del 1 % -2 % del total de las tuberculosis. En los últimos tiempos se ha visto un resurgimiento de la tuberculosis cutánea que se corresponde con el aumento en la incidencia de la tuberculosis en todo el mundo. Se reporta el caso de un paciente varón de 22 años con una tumoración fluctuante en la axila derecha que correspondió a una tuberculosis colicuativa o escrofuloderma y evolucionó favorablemente al tratamiento antituberculoso; una primera fase con rifampicina 600 mg/día, isoniacida 300 mg/día, pirazinamida 1.5 g/día y tambutol 1.2g/día, diario excepto domingos y feriados por 2 meses; seguidos de una segunda fase con isoniacida 800mg/d y rifampicina 600mg/d, dos veces por semana por 4 meses, observándose una resolución completa del proceso. Presentamos este caso por ser una entidad de difícil diagnóstico, por su variada presentación clínica y la dificultad de su confirmación diagnóstica.

The colliquative cutaneous tuberculosis is achronic infectious disease caused by Mycobacterium tuberculosis. It appears ina broad clinical spectrum that depends onthe orute of arrival of the bacillus to the skin and on the immunological condition of the guest; the majority come from endogenous. Tuberculosis is a disease og high prevalence in developing countries as ours, being the cutaneous forms near 1 û 2% of the total. Now a days it has seen a revival of the cutaneous tuberculosis corresponding to the increase in the incident of tuberculosis in the world. This is the case of a 22 year-old male patient with a fluctuating tumor in the right axilla that correrponded to a collicuative cutaneous tuberculosis or scrofuloderma and favorably outcome with the antituberculosis treatment. The initial phase with rifampin 600 mg/day and etambutol 1,2 g/ day, except on Sundays and hoilidays during 2 months, followed by the second phase with isoniazid 800 mg/d and rifampicin 600 mg(day twice a week for 4 months. A full clinical recovery was observed. This case is brought due to its difficult diagnose, its clinical spectrum and the difficulty of the diagnose confirmation.

Vitamin D, innate immunity and upper respiratory tract infection.

INTRODUCTION: At the turn of the twentieth century, ultraviolet light was successfully used to treat tuberculosis of the skin. Upper respiratory tract infections had been inversely associated with sun exposure. During the last decade, basic scientific research demonstrated that vitamin D has an important anti-infective role. METHOD: Review of the relevant literature on the influence of vitamin D on innate immunity and respiratory tract infection. RESULTS: Vitamin D is involved in the production of defensins and cathelicidin - antimicrobial peptides that provide a natural defence against potential microbiological pathogens. Vitamin D supplementation increases cathelicidin production. Low vitamin D levels are associated with an increased incidence of upper respiratory tract infections. CONCLUSIONS: Vitamin D appears to play an important role in the regulation of innate immunity in the upper respiratory tract. Optimal vitamin D levels and appropriate dosing schedules have yet to be determined.

Chronic Mycobacterium infection of first dorsal web space after accidental Bacilli Calmette-Guérin injection in a health worker: case report.

We present a case of inoculation of the first dorsal web space by a nurse practitioner who accidentally stuck herself while preparing Bacilli Calmette-Guérin vaccine for treatment of bladder tumor. We report the evolution and management of this resistant chronic Mycobacterium infection that ultimately required use of a vacuum wound management system followed by a microvascular free tissue transfer.

Clinical and epidemiological study of cutaneous tuberculosis in Northern Ethiopia.

BACKGROUND: Tuberculosis is a major public health problem in Ethiopia but cutaneous tuberculosis (CT) has not been documented. OBJECTIVE: This study was conducted to determine its existence and its clinical pattern in Tigray, a northern region of Ethiopia. METHODS: We report 202 cases of CT who attended the Italian Dermatological Centre in the 34-month period between January 2005 and October 2007. The diagnosis was made on a clinical, cytological and histological basis. RESULTS: Clinically, 143 cases of scrofuloderma, 22 of lupus vulgaris, 18 of gumma, 11 of lichen scrofulosorum, 6 of tuberculosis verrucosa cutis and 2 of erythema induratum of Bazin were observed in our department. All patients were aged between 18 months and 69 years, and 49 were paediatric cases. Forty-five were HIV positive. CONCLUSION: The number of CT cases observed in the period of 34 months indicates a high incidence of the disease in the region also in the paediatric age. CT is still underdiagnosed due to the low number of dermatologists as well as the poor life conditions of the population and the traditional belief in magic medicine. The current study may therefore provide some indication about the epidemiology of CT in Ethiopia.

Vacuum-assisted closure of a large palmar defect after debriding a midpalmar tuberculous abscess.

A rare case of tuberculous deep palmar abscess of the hand was treated with radical excisional debridement, resulting in a large palmar skin and soft tissue defect that was successfully closed with a vacuum dressing followed by split skin grafting. Vacuum dressings are useful adjuncts to treat large soft tissue defects in patients who are unsuitable for complex reconstruction. The moist wound environment prevents desiccation of exposed vital structures and decreases pain, allowing early mobilisation in the hand. The wound granulates and contracts rapidly, allowing earlier skin grafting or faster healing by secondary intention. The closed system vacuum dressing is particularly useful in managing debrided tuberculous soft tissue infections. The dressing is perfectly sealed and requires less frequent changing, decreasing contamination and transmission of tuberculosis to other patients and health care staff, while minimising the risk of secondary nosocomial bacterial infection of the wound.