Case Report: Clinical and Pathological Findings of Tuberculous Gumma: A Case Report and Literature Review.

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.

Rare concurrence of lepromatous leprosy and cutaneous tuberculosis.

The coinfection of leprosy and tuberculosis has been rarely reported in literature. A middle-aged man who was a known case of hepatitis B infection had presented with ichthyosis with claw hand deformity and submandibular swelling, which were diagnosed with lepromatous leprosy and scrofuloderma, respectively.

Cutaneous Tuberculosis in Heart Transplant.

Tuberculosis is a disease with a significant global burden in terms of morbidity and mortality. It usually presents as a pulmonary disease but can occasionally have extrapulmonary presentations. Immunosuppressed people are at an increased risk of tuberculosis and more frequently have atypical manifestations of the disease. Cutaneous involvement is estimated to occur in only 2% of extrapulmonary presentations. We report a case of a heart transplant recipient with disseminated tuberculosis who initially presented with cutaneous manifestations in the form of multiple abscesses that were mistaken for a community-acquired bacterial infection. The diagnosis was made after positive nucleic acid amplification testing and cultures for Mycobacterium tuberculosis from the drainage of the abscesses. After initiating antituberculous treatment, the patient had 2 instances of immune reconstitution inflammatory syndrome. A combination of diminished immunosuppression due to discontinuation of mycophenolate mofetil in the setting of acute infection, rifampin drug interactions with cyclosporine, and the beginning of treatment of tuberculosis all contributed to this paradoxical worsening. The patient responded favorably to increased glucocorticoid therapy and showed no signs of treatment failure after 6 months of antituberculous therapy.

Cutaneous Tuberculosis among Patients Presenting to Dermatology Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Cutaneous tuberculosis is an uncommon form of extrapulmonary tuberculosis. It can present in various morphological presentations leading to a late diagnosis in many cases. It is mainly associated with significant scarring and morbidity. It is classified as paucibacillary or multibacillary depending on the bacillary load. Similarly, it can be acquired through either an endogenous or an exogenous source. The mainstay of treatment is anti-tubercular medications. The objective of the study was to find out the prevalence of cutaneous tuberculosis among patients presenting to the dermatology outpatient department of a tertiary care centre. Methods: A descriptive cross-sectional study was done among the patient presenting to the outpatient department of dermatology and venerology in a tertiary care centre where all patients data from medical records were taken from April 2016 to March 2021 after taking ethical approval from the Institutional Review Committee (Reference number: 503/2078/79). Demographic details of the patients including age, sex, site and duration of the lesion were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 1,30,924 cases, 40 (0.03%) (0.02-0.04, at 95% Confidence Interval) cutaneous tuberculosis was seen. Conclusions: The prevalence of cutaneous tuberculosis was similar to the studies done in similar settings. Keywords: cutaneous; extrapulmonary tuberculosis; tuberculid.

Undermined Skin Lesion Emerged as Tubercular Meningitis: A Case Report.

Cutaneous tuberculosis is a rare type of extrapulmonary tuberculosis and it is uncommon even in places where tuberculosis is widespread. A 32-year-old female presented with fever and headache along with prior history of an ulcer in her leg which was treated as cellulitis at another centre. The neck rigidity, and the Kernig and Budzinski sign were also positive. There were also features of increased intracranial pressure. The non-contrast computed tomography showed bilateral hydrocephalus and hypodense areas. She was managed for increased intracranial pressure and anti-tubercular therapy for disseminated tuberculosis. Biopsy of non-healing wounds should be checked for lupus vulgaris. Keywords: case reports; lupus vulgaris; meningitis; skin; tuberculosis.

Atypical cutaneous tuberculosis with an unusual course.

Cutaneous tuberculosis represents the fifth extrapulmonary form in Morocco after pleural, lymph node, urogenital, and intestinal tuberculosis. It is recognized to form a continuous immunopathologic spectrum, ranging from a high intensity to a low intensity of cell-mediated immunity, which explains the multiplicity and heterogeneity of anatomo-clinical forms. Association of multiple forms in the same patient is really rare. In this regard, we report a case of scrofuloderma on axillary tuberculosis adenitis associated to a lupus vulgaris in an immunocompetent patient, which was confirmed by histology, QuantiFERON-TB Gold test, and polymerase chain reaction. He received an antituberculous therapy with clinical regression of the lesions. In conclusion, cutaneous tuberculosis is still endemic in developing countries.The diagnosis is difficult because of its clinical polymorphism. That's why it's should be suspected clinically in the presence of any destructive or verrucous skin lesion evolving without healing for a long period and confirmed by bacteriological examinations and histology.

Multiple diagnostic examinations are effective for the early diagnosis of scrofuloderma.

Although scrofuloderma is the most common subtype of cutaneous tuberculosis, its diagnosis is often delayed. In this case, ciprofloxacin was first administered as only Pseudomonas aeruginosa was detected by initial culture tests. Mycobacterium tuberculosis is usually susceptible to quinolone antibiotics, hence the partial improvement in inflammatory symptoms and subsequent delay in diagnosis. Our case serves as a reminder that we should always be aware of the possibility of cutaneous tuberculosis being the cause of an abscess, especially when the abscess is not completely resolved by antibiotics. Moreover, our case reminds us that it is necessary to conduct repeated culture tests, rather than relying purely on polymerase chain reaction (PCR) results, given that cases of PCR-negative acid-fast bacilli (AFB) culture-positive scrofuloderma have been reported. Fine needle aspiration is a less invasive and useful way to collect culture samples.

Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment.

Despite the availability of effective treatment regimens for cutaneous tuberculosis, challenges to disease control result from delayed diagnosis, infection with multidrug-resistant mycobacterial strains, and coinfection with HIV. Delayed diagnosis can be mitigated when dermatologists are sensitized to the clinical signs and symptoms of infection and by the incorporation of appropriate diagnostic tests. All cases of cutaneous tuberculosis should be confirmed with histopathology and culture with or without molecular testing. In each case, a thorough evaluation for systemic involvement is necessary. Mycobacteria may not be isolated from cutaneous tuberculosis lesions and therefore, a trial of antituberculosis treatment may be required to confirm the diagnosis. The second article in this 2-part continuing medical education series describes the sequelae, histopathology, and treatment of tuberculosis.

Co-existence of atypical tuberculid with lupus vulgaris.

Cutaneous tuberculosis (CTB) is an uncommon form of extra-pulmonary tuberculosis accounting for ≤2% of mycobacterium tuberculosis cases and is more often reported from developing countries. Tuberculid, a cutaneous hypersensitivity reaction to mycobacteria or its fragments, is a another rare cutaneous manifestation seen in association with tuberculosis of other organ systems including tuberculous lymphadenitis, pulmonary tuberculosis, etc. Co-occurrence of a tuberculid with CTB is extremely rare. Herein we report a childhood case of lupus vulgaris, a type of CTB, associated with an atypical presentation of tuberculid.

Multiple diagnostic examinations are effective for the early diagnosis of scrofuloderma.

Although scrofuloderma is the most common subtype of cutaneous tuberculosis, its diagnosis is often delayed. In this case, ciprofloxacin was first administered as only Pseudomonas aeruginosa was detected by initial culture tests. Mycobacterium tuberculosis is usually susceptible to quinolone antibiotics, hence the partial improvement in inflammatory symptoms and subsequent delay in diagnosis. Our case serves as a reminder that we should always be aware of the possibility of cutaneous tuberculosis being the cause of an abscess, especially when the abscess is not completely resolved by antibiotics. Moreover, our case reminds us that it is necessary to conduct repeated culture tests, rather than relying purely on polymerase chain reaction (PCR) results, given that cases of PCR-negative acid-fast bacilli (AFB) culture-positive scrofuloderma have been reported. Fine needle aspiration is a less invasive and useful way to collect culture samples.

Multifocal cutaneous tuberculosis coexisting with pulmonary tuberculosis.

Tuberculosis (TB) is caused by Mycobacterium tuberculosis and it can affect multiple organ systems. Cutaneous TB, a less common type of extrapulmonary TB can coexist with TB of other organs. Here, we describe a case of multifocal cutaneous TB suggestive of two different morphological types with concomitant miliary pulmonary TB.

Vulvar ulcerative cutaneous tuberculosis secondary to genital tract tuberculosis.

Tuberculosis is a chronic infectious disease that gradually poses a certain threat to public health and economic growth. Tuberculosis typically affects the lungs, pleura, and lymph nodes and rarely the skin. Cutaneous tuberculosis manifesting as ulcerated lesions is also rare and often misdiagnosed and missed by clinicians. Here, the authors report a 29-year-old female patient presenting a vulvar ulcer for 10 months, accompanied by irregular menstruation and increased vaginal secretions. After a skin biopsy and endometrial PCR testing, it was finally diagnosed as vulvar ulcerative cutaneous tuberculosis secondary to genital tuberculosis. Anti-tuberculosis treatment was effective. Cutaneous tuberculosis is called a great imitator. In order to facilitate the diagnosis and treatment of tuberculosis by clinicians, the authors systematically reviewed this disease as well.

[Erythema induratum of Bazin as a reactivation of latent tuberculosis infection in a patient receiving anti-tumor necrosis factor treatment]. / Eritema indurado de Bazin como una reactivación de una tuberculosis latente en una paciente con tratamiento biológico anti-factor de necrosis tumoral.

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.

Papulonecrotic tuberculid.

Papulonecrotic tuberculid (PNT) is an uncommon form of id eruption, which occurs in association with tuberculosis infections in patients with a high degree of immunity and allergic sensitivity to mycobacterial organisms. It commonly presents as recurrent crops of papulonecrotic lesions that crust or ulcerate, and heal with atrophic varioliform scars over time. The differential diagnoses of PTN are wide and varying. Tuberculin test is usually strongly positive. Histology shows tuberculoid histology with endarteritis and thrombosis of dermal blood vessels. One of the hallmarks of PNT is its prompt response to antituberculous therapy. The purpose of this article is to increase awareness of this condition among dermatologists.