RESUMO
Tuberculosis is one of the oldest known diseases and it remains one of the main causes of morbidity and mortality, especially in developing countries. It is associated with social inequalities and affects different age groups. Tuberculosis in children and adolescents should be considered a sentinel event, since it is linked to a recent infection through contact with bacilliferous adults. We report an immunocompetent 15-year-old adolescent with tuberculosis, exhibiting pulmonary, osteoarticular, and cutaneous involvement. Conventional treatment with tuberculostatic drugs for a year had satisfactory results without sequelae.
Assuntos
Antituberculosos , Imunocompetência , Humanos , Adolescente , Antituberculosos/uso terapêutico , Masculino , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/patologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Osteoarticular/tratamento farmacológico , Tuberculose Osteoarticular/diagnósticoAssuntos
Hidradenite Supurativa , Linfadenopatia , Tuberculose Cutânea , Humanos , Hidradenite Supurativa/diagnóstico , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/patologia , Tuberculose Cutânea/tratamento farmacológico , Diagnóstico Diferencial , Masculino , Linfadenopatia/patologia , Tuberculose dos Genitais Masculinos/diagnóstico , Tuberculose dos Genitais Masculinos/tratamento farmacológico , Tuberculose dos Genitais Masculinos/patologia , AdultoRESUMO
This case report describes induration of the right breast with multiple painful ulcers, draining nodules, and fistulae.
Assuntos
Mastite , Humanos , Feminino , Mastite/microbiologia , Mastite/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Antituberculosos/administração & dosagem , Tuberculose/diagnóstico , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/patologia , Tuberculose Cutânea/microbiologiaAssuntos
Antituberculosos , Mycobacterium tuberculosis , Exposição Ocupacional , Tuberculose Cutânea , Médicos Veterinários , Humanos , Masculino , Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Pele/patologia , Pele/microbiologia , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/microbiologia , Tuberculose Cutânea/patologia , Pessoa de Meia-Idade , Biópsia , Isoniazida/uso terapêutico , Rifampina/uso terapêutico , Etambutol/uso terapêutico , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/microbiologia , Dermatoses da Mão/patologia , Exposição Ocupacional/efeitos adversosRESUMO
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.
Assuntos
Lúpus Vulgar , Mycobacterium tuberculosis , Tuberculose Cutânea , Masculino , Humanos , Criança , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Lúpus Vulgar/patologia , Antituberculosos/uso terapêutico , Pele/patologiaRESUMO
BACKGROUND: Erythema induratum (EI) is a tuberculid associated with Mycobacterium tuberculosis infection. Using polymerase chain reaction (PCR), M. tuberculosis has been identified in Taiwan with a high percentage of EI. However, this pathogen is now rarely detected in Taiwan. OBJECTIVES: To explore the association between EI, the annual incidence of tuberculosis (TB) in Taiwan and treatment outcomes over the last two decades. METHODS: Patients diagnosed with EI between 2001 and 2020 were enrolled based on histopathology, tissue culture and positive M. tuberculosis PCR tests. Other cases of panniculitis with positive M. tuberculosis PCR results were used as controls. The clinical information of participants was obtained. The results were correlated with the annual incidence of TB and compared between groups. RESULTS: Fifty-five biopsy specimens from patients with EI met the inclusion criteria; three (5%) had positive M. tuberculosis PCR results. One patient diagnosed with erythema nodosum in the control group had a positive M. tuberculosis PCR (n = 1/27; 4%). There was no significant relationship between M. tuberculosis and EI (odds ratio 1.5, 95% confidence interval -0.964 to 3.964). The correlation between the incidence of M. tuberculosis and the number of EI cases was not statistically significant (r = -0.185, P = 0.45). Only four patients received anti-TB treatment; they all showed clinical improvement without recurrence. One patient with M. tuberculosis PCR-positive EI was not treated with anti-TB therapy; however, the skin lesion improved after 3â months. No other patients in the EI group were diagnosed with M. tuberculosis infection over a follow-up period of 508 person-years. CONCLUSIONS: Most cases of EI in Taiwan are nodular vasculitis and not tuberculid, owing to well-controlled TB. This condition can be alleviated without anti-TB treatment.
Assuntos
Antituberculosos , Eritema Endurado , Mycobacterium tuberculosis , Humanos , Taiwan/epidemiologia , Eritema Endurado/tratamento farmacológico , Eritema Endurado/epidemiologia , Antituberculosos/uso terapêutico , Incidência , Feminino , Masculino , Adulto , Estudos de Casos e Controles , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Idoso , Adulto Jovem , Reação em Cadeia da Polimerase , Adolescente , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/epidemiologia , Tuberculose Cutânea/diagnósticoRESUMO
Tuberculosis can present with diverse manifestations, particularly in immunocompromised hosts. Although cold abscesses can complicate spinal tuberculosis, subcutaneous abscesses due to tuberculosis are considerably uncommon and, unlike cold abscesses, necessitate surgical drainage.1 We present an extremely rare case of disseminated tuberculosis in a patient with subcutaneous involvement mimicking cellulitis.
Assuntos
Abscesso , Dermatomiosite , Adulto , Humanos , Masculino , Abscesso/etiologia , Abscesso/diagnóstico , Abscesso/microbiologia , Antituberculosos/uso terapêutico , Dermatomiosite/complicações , Dermatomiosite/diagnóstico , Diagnóstico Diferencial , Hospedeiro Imunocomprometido , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/complicações , Tuberculose Cutânea/tratamento farmacológicoRESUMO
Resumen El eritema indurado de Bazin es una tuberculosis cutánea rara, considerada una tuberculide o reacción de hipersensibilidad a Mycobacterium tuberculosis. El tratamiento con agentes biológicos es un factor de riesgo conocido para la reactivación de tuberculosis, especialmente en áreas de alta incidencia como Latinoamérica, por lo que existen protocolos de búsqueda y tratamiento antes del inicio de este tipo de terapias. Se presenta un caso clínico de eritema indurado de Bazin como reactivación de una infección tuberculosa latente en una paciente con artritis reumatoide que recibía tratamiento con golimumab.
Abstract Erythema induratum of Bazin is a rare form of cutaneous tuberculosis, considered as part of the spectrum of tuberculids or hipersensitivity reactions to Mycobacterium tuberculosis. Treatment with biologic agents is a known risk factor for tuberculosis reactivation, especially in areas of high incidence like Latin America, which is why screening and treatment protocols must be followed before these therapies are initiated. We present a case of erythema induratum of Bazin as a reactivation of latent tuberculosis infection in a patient with rheumatoid arthritis treated with golimumab.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/microbiologia , Tuberculose Cutânea/tratamento farmacológico , Eritema Endurado/diagnóstico , Eritema Endurado/microbiologia , Eritema Endurado/patologia , Tuberculose Latente/complicações , Tuberculose Latente/tratamento farmacológico , Mycobacterium tuberculosis , Antituberculosos/uso terapêuticoRESUMO
Abstract As the treatment of infectious and parasitic diseases improved, the prevalence of these conditions declined. However, with the expansion of the use of immunobiologicals, opportunistic infections have emerged, especially under atypical presentations. The present study reports the case of a patient treated with infliximab for Crohn's disease, who presented diarrhea, weight loss, abdominal pain, fever, and subcutaneous erythematous nodules that evolved with spontaneous fluctuation and ulceration. With the finding of alcohol-resistant bacilli and Mycobacterium tuberculosis DNA in a cutaneous fragment, through polymerase chain reaction, the diagnosis of gummatous tuberculosis was confirmed, probably secondary to hematogenous dissemination from an intestinal focus.
Assuntos
Humanos , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/induzido quimicamente , Tuberculose Cutânea/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Sífilis , Pele , Infliximab/efeitos adversosRESUMO
Abstract Cutaneous tuberculosis is a rare infection that is difficult to diagnose, because it shows less sensitivity and specificity in classic complementary exams when compared with the pulmonary form. The Xpert MTB/RIF® method offers an early diagnosis that identifies the DNA of Mycobacterium tuberculosis and the main mutations that give the bacterium resistance to rifampicin. The authors present a case of scrofuloderma whose diagnosis was quickly obtained through the secretion of a cervical lesion, allowing an early diagnosis and the initiation of appropriate treatment.
Assuntos
Humanos , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Antibióticos Antituberculose/uso terapêutico , Antibióticos Antituberculose/farmacologia , Mycobacterium tuberculosis/genética , Rifampina/uso terapêutico , Sensibilidade e Especificidade , Farmacorresistência Bacteriana , LinfonodosRESUMO
ABSTRACT Tuberculosis verrucosa cutis is a rare medical condition that is caused by the inoculation of Mycobacterium tuberculosis into the skin of a previously sensitized individual. This clinical form of tuberculosis corresponds to 1-2% of all cases of tuberculosis and due to the paucibacillary characteristic of the lesions, patients can be misdiagnosed, accounting for the chronification of the skin infection. Herein, we report the case of a 26-year-old male farmer, presenting plaques with verrucosa and hyperkeratosis features in the left thigh and buttocks during 15 years. M. tuberculosis was identified by PCR and the patient was treated with standard anti-tuberculosis drugs, with subsequent improvement of the skin lesions.
Assuntos
Humanos , Masculino , Adulto , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Mycobacterium tuberculosis/genética , Pele , Brasil , Antituberculosos/uso terapêuticoRESUMO
La tuberculosis (TBC) es una enfermedad infecciosa causada por organismos del complejo Mycobacterium tuberculosis. Las presentaciones extrapulmonares constituyen hasta el 25% de los casos de TBC reportados en nuestro país. La TBC cutánea es una manifestación extrapulmonar rara que representa el 1-2% de los casos, siendo el escrofuloderma y el lupus vulgar las formas clínicas más comunes. El escrofuloderma es una manifestación endógena de la infección, como resultado de la extensión contigua a la piel suprayacente desde estructuras adyacentes. La biopsia de piel asociada a técnicas moleculares y cultivo de micobacterias constituyen el gold standard diagnóstico de la TBC cutánea. El tratamiento de la TBC cutánea sigue las mismas recomendaciones que para otras formas de TBC. Presentamos el caso de un paciente con escrofuloderma.
Tuberculosis (TB) is an infectious disease caused by organisms of the Mycobacterium tuberculosis complex. Extrapulmonary presentations may constitutes up to 25% of TB cases. Reported in our country Cutaneous tuberculosis is a rare extrapulmonary manifestation that represents 1-2% of cases, with scrofuloderma and lupus vulgaris being the most common clinical forms. Scrofuloderma is an endogenous manifestation of the infection, because of contiguous extension to the overlying skin from adjacent structures. Skin biopsy associated with molecular techniques and mycobacterial culture constitute the gold standard for diagnosis of cutaneous TB. The treatment of cutaneous TB follows the same recommendations as for other forms of TB. We present the case of a patient with scrofuloderma.
Assuntos
Humanos , Masculino , Idoso , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/patologia , Tuberculose Cutânea/classificação , Tuberculose Cutânea/microbiologia , Tuberculose Cutânea/tratamento farmacológico , Chile , Mycobacterium tuberculosis/isolamento & purificação , Antituberculosos/uso terapêuticoRESUMO
Abstract Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.
Assuntos
Humanos , Masculino , Adulto Jovem , Tuberculose Cutânea/imunologia , Tuberculose Cutânea/patologia , Hospedeiro Imunocomprometido , Artrite Reativa/imunologia , Imunocompetência , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Úlcera Cutânea/imunologia , Úlcera Cutânea/patologia , Úlcera Cutânea/tratamento farmacológico , Tuberculose Cutânea/tratamento farmacológico , Resultado do Tratamento , Etambutol/uso terapêutico , Isoniazida/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Antituberculosos/uso terapêuticoAssuntos
Humanos , Masculino , Adolescente , Neoplasias Torácicas/diagnóstico , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/patologia , Tuberculose Cutânea/tratamento farmacológico , Resultado do Tratamento , Diagnóstico Diferencial , Antibióticos Antituberculose/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificaçãoRESUMO
RESUMEN La tuberculosis cutánea representa menos del 2% de todos los casos de la infección por Mycobacterium tuberculosis. Su baja prevalencia, asociada a la amplia variedad en la presentación clínica de las lesiones, dificulta y retrasa el diagnóstico y, por tanto, el inicio del tratamiento. El siguiente es el caso de una paciente de 80 años, con una lesión ulcerada, crónica, en pabellón auricular izquierdo, con evolución tórpida y pobre respuesta al manejo farmacológico instaurado; con biopsia de piel que mostró reacción inflamatoria crónica y presencia de bacilos ácido-alcohol resistentes.
ABSTRACT Cutaneous tuberculosis represents less than 2% of all cases of infection with Mycobacterium tuberculosis. Its low prevalence, associated with a wide variety in clinical presentation of the lesions, hinders and delays the diagnosis and, thus, treatment initiation. The following is the case of an 80-years old, female patient with an ulcerated, chronic lesion in the left ear auricle, with a torpid evolution and poor response to established pharmacological management; with a skin biopsy that showed chronic inflammatory reaction and the presence of acid-fast bacilli.
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Pavilhão Auricular/patologia , Tuberculose Cutânea/patologia , Pavilhão Auricular/microbiologia , Mycobacterium tuberculosisRESUMO
Relatamos um caso de tuberculose cutânea do tipo eritema indurado de Bazin em paciente do sexo feminino, 26 anos de idade, com presença de úlceras e nódulos infiltrados, eritêmato- ferruginosos, com áreas de supuração e de aspecto endurecido em região de membro inferior esquerdo. O diagnóstico foi feito por meio da detecção de DNA micobacteriano nas lesões cutâneas por meio do método de reação em cadeia da polimerase. Realizou-se tratamento com pirazinamida, rifampicina, isoniazida e etambutol, obtendo-se melhora clínica e resolução das lesões cutâneas da paciente.(AU)
We report a clinical case of Erythema Induratum of Bazin cutaneous tuberculosis on a 26-year-old female patient that presented with ulcers and erythematous-ferruginous infiltrated nodules, with hardened suppuration areas on left lower limb. Diagnosis was made through mycobacterian DNA detection on cutaneous lesions using the chain polymerase reaction method. The treatment was carried out with Pyrazinamide, Rifampicin, Isoniazid and ethambutol, which provided clinical improvement and resolution of the patient's cutaneous lesions.(AU)