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1.
Int J Mycobacteriol ; 8(3): 292-294, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31512607

RESUMO

Most common form of cutaneous tuberculosis (TB) is lupus vulgaris (LV). Atypical presentation of LV is rare and may lead to delay in diagnosis and hence increase in morbidity. Here, we report a case of sporotrichoid form of LV in a 38 year old male who presented as cutaneous lesions mimicking mycetoma. High index of clinical suspicion and relevant investigations play a vital role in confirmation of diagnosis wherever atypical form of cutaneous TB is suspected.


Assuntos
Lúpus Vulgar/diagnóstico , Tuberculose Cutânea/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Humanos , Lúpus Vulgar/tratamento farmacológico , Lúpus Vulgar/microbiologia , Masculino , Micetoma/diagnóstico , Esporotricose/diagnóstico , Tuberculose Cutânea/complicações , Tuberculose Cutânea/microbiologia
3.
Med Sante Trop ; 29(2): 139-141, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31379337

RESUMO

Cutaneous tuberculosis with lymphatic spread is rarely described. We report the case of a woman aged 38, immunocompetent, working in a fruit sorting center, who consulted us for ulceration of the left third finger that had persisted for four months, following a prick from a prickly pear. Physical examination revealed a nodular, erythematous, and ulcerative lesion of the left third finger, associated with inflammatory subcutaneous nodules arranged in a line along the ipsilateral upper extremity and an ipsilateral axillary lymph node. Laboratory tests and chest X-ray were normal. Pathological examination revealed granulomatous chronic inflammation without necrosis. PCR detected DNA from Mycobacterium tuberculosis. No extracutaneous tuberculosis locations were detected. A tuberculous chancre by direct inoculation was therefore diagnosed. The patient received quadruple therapy (rifampicin + isoniazid + pyrazinamide + ethambutol) for 2 months, followed by a combination therapy based on isoniazid and rifampicin for 6 months. Marked regression of the cutaneous lesions occurred after 1 month of first-line therapy. A tuberculous chancre is a rare form of cutaneous tuberculosis, with possible lymphatic spread, in immunocompromised patients but also in immunocompetent children and young adults.


Assuntos
Tuberculose Cutânea/complicações , Tuberculose dos Linfonodos/etiologia , Adulto , Feminino , Humanos , Imunocompetência , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/tratamento farmacológico
4.
Indian J Ophthalmol ; 67(7): 1207-1209, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238468

RESUMO

The tuberculids are a group of distinct clinicopathological form of skin lesions representing hypersensitivity reaction to hematogenous dissemination of Mycobacterium tuberculosis or its antigen from an underlying active or a silent focus of tuberculosis elsewhere in the body in an individual with a strong antituberculous cell-mediated immunity and by definition do not show bacilli on special stains and are culture-negative. Ocular involvement can occur in tuberculosis, both due to direct invasion by the bacilli as well as an immune-mediated reaction; however, immune-mediated tuberculous uveitis occurring as a hypersensitivity response in association with PNT has hardly been reported in the literature. Here we report one such rare case.


Assuntos
Antígenos de Bactérias/imunologia , Infecções Oculares Bacterianas/imunologia , Mycobacterium tuberculosis/imunologia , Pele/patologia , Tuberculose Cutânea/complicações , Tuberculose Ocular/imunologia , Uveíte/imunologia , Adulto , Biópsia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/etiologia , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Necrose , Pele/microbiologia , Tuberculose Cutânea/diagnóstico , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/etiologia , Uveíte/diagnóstico , Uveíte/etiologia
5.
Clin Dermatol ; 37(3): 192-199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31178102

RESUMO

Tuberculosis (TB) is still prevalent in many developing countries and can pose a new potential threat to global health due to international migration. As an uncommon form of extrapulmonary TB, cutaneous TB is complicated in its clinical manifestation, pathogenesis, and classification. Cutaneous TB can be divided into two major categories, true cutaneous TB and tuberculid, depending on the source of infection, the route of transmission, the amount of bacteria, and the immune state of the host. Clinical manifestations may include patches and plaques (lupus vulgaris, TB verrucosa cutis), macules and papules (acute miliary TB, papulonecrotid tuberculid, lichen scrofulosorum), nodules, and abscesses (erythema induratum of Bazin, tuberculous gumma), erosions, and ulcers (tuberculous chancre, orificial TB, scrofuloderma), mimicking diverse skin diseases. Uncommon localizations such as external genitalia, unusual presentations such as nodular granulomatous phlebitis, and coexistence with other morbidities such as Behçet disease and acne inversa or hidradenitis suppurativa deserve special attention. Treatment of both true and tuberculid cutaneous TB follows the same drug regimens of the World Health Organization's recommendation for treatment of new cases of pulmonary TB. Erythema induratum of Bazin may need longer treatment duration and adjuvants such as dapsone, potassium iodide, doxycycline, and corticosteroids to tackle inflammation. Misdiagnosis and undertreatment in daily practice are likely, and contemplation of this classic great imitator in dermatology is warranted.


Assuntos
Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Adolescente , Corticosteroides/administração & dosagem , Adulto , Antituberculosos/uso terapêutico , Criança , Dapsona/administração & dosagem , Diagnóstico Diferencial , Erros de Diagnóstico , Doxiciclina/administração & dosagem , Quimioterapia Combinada , Feminino , Infecções por HIV , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Iodeto de Potássio/administração & dosagem , Pele/microbiologia , Pele/patologia , Tuberculose Cutânea/microbiologia , Tuberculose Cutânea/patologia , Adulto Jovem
6.
Int J Mycobacteriol ; 8(2): 202-204, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210168

RESUMO

Elephantiasis nostras verrucosa is used to describe lymphedema of the lower limbs caused by a nonfilarial etiology. Infective etiologies include bacterial and fungal infections along with chronic venous stasis, postirradiation, congestive heart failure, obesity, and malignancies, all causes leading to lymphatic obstruction and edema. We herein describe a case of a 70-year-old male who presented with diffuse nonpitting edema of the entire left lower limb with cobblestoning of the surface with a positive Kaposi-Stemmer sign and presence of a verrucous plaque over the left ankle. Histopathology of the verrucous plaque revealed it to be tuberculosis verrucosa cutis (TVC). We report this rare presentation of TVC as a cause of unilateral lymphedema.


Assuntos
Elefantíase/microbiologia , Extremidade Inferior/microbiologia , Tuberculose Cutânea/diagnóstico , Idoso , Antituberculosos/uso terapêutico , Humanos , Extremidade Inferior/patologia , Masculino , Resultado do Tratamento , Tuberculose Cutânea/complicações , Tuberculose Cutânea/tratamento farmacológico
7.
Diagn Cytopathol ; 47(9): 935-938, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31173479

RESUMO

Nocardiosis is primarily a pulmonary infection commonly seen in immunocompromised individuals. However, lymphocutaneous nocardiosis is observed in immunocompetent individuals often after trauma. The clinical and cytomorphological features of lymphocutaneous nocardiosis closely mimic the most common infections in India such as tuberculosis and mycetoma (very common cutaneous infection with discharging sinus). As it is crucial to differentiate nocardiosis from tuberculosis, to avoid unnecessary antitubercular treatment, special stains like modified Ziehl-Neelsen stain and Gram stain can be employed to differentiate the morphology of Nocardia from tuberculosis. Fine-needle cytology from these cutaneous lesions helps in yielding adequate material for rapid and accurate diagnosis of immediate specific antibiotic treatment. We report a rare case that presented with clinical diagnosis of tuberculosis but turned out to be nocardiosis on cytomorphology with simple and most feasible fine-needle aspiration method of tissue diagnosis and scrape cytology.


Assuntos
Nocardiose , Nocardia/metabolismo , Tuberculose Cutânea , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Nocardiose/diagnóstico , Nocardiose/metabolismo , Nocardiose/patologia , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/metabolismo , Tuberculose Cutânea/patologia
8.
Rev. méd. Urug ; 35(2): 155-164, jun. 2019. fig
Artigo em Espanhol | LILACS | ID: biblio-999629

RESUMO

La tuberculosis cutánea es una enfermedad infecciosa crónica y poco frecuente ocasionada por Mycobacteriun tuberculosis. Existen varias formas de la infección cutánea, siendo el lupus vulgar la más frecuente y común en los países industrializados. Las variantes clínicas dependerán de la vía de llegada del bacilo a la piel, del estado inmunológico del paciente y del medio ambiente. En el lupus vulgar, además de M. tuberculosis puede estar implicado M. bovis y menos frecuentemente el bacilo de Calmette y Guérin. Esta entidad presenta una evolución crónica, es de carácter progresivo y es rara de ver en niños. Se presenta el caso de una niña en la cual se diagnosticó una forma de tuberculosis cutánea denominada lupus vulgar provocada por el bacilo de Calmette y Guérin. Caso clínico: niña de 10 años que presentaba lesiones cutáneas de diferentes características, de evolución tórpida y asintomáticas; la de mayor tamaño se localizaba en la cara externa del deltoides derecho en forma de placa eritematosa de 20 por 10 cm con bordes sobreelevados presentando en su centro micropápulas que coalescen dejando una zona de atrofia central. Esta había comenzado en etapa neonatal luego de la vacunación por el bacilo de Calmette y Guérin. Desde hacía tres años presentaba una segunda lesión más pequeña en cara externa de muslo derecho de similares características y otras de carácter múltiple en dorso con forma de micropápulas rojo vinosas. Los exámenes de valoración general fueron normales, al igual que la radiografía de tórax y de los miembros. El test de la tuberculina mostró una induración de 15 mm y las baciloscopias fueron negativas. La biopsia de la lesión de piel del deltoides mostró granulomas caseosos y las técnicas moleculares diagnosticaron Mycobacterium bovis atenuado. Con ese diagnóstico, recibió tratamiento antituberculoso por diez meses con buena tolerancia y con mejoría de las lesiones.


Cutaneous TB is a rather unusual chronic infectious disease caused by Mycobacteriun tuberculosis. There are several forms of cutaneous infection, lupus vulgaris being the most frequent and ordinary one in developed countries. Clinical variations will depend on the site of infiltration of the skin by the bacillus, the patient's immune condition and the environment. In the case of lupus vulgaris, apart from Mycobacteriun tuberculosis, M. bovis may be involved, and the Bacille Calmette Guérin involvement is less frequent. The latter presents a chronic evolution, being progressive and unusual in children. The study presents the case of a girl who was diagnosed with a form of cutaneous tuberculosis called lupus vulgaris caused by the Bacille Calmette-Guérin vaccine. Clinical case: a 10 year old girl who evidenced skin lesions of different kinds, of slow evolution and asymptomatic: the largest one was in the external part of the right deltoid muscle as an erythematous plaque of 20 by 10 cm with higher borders evidencing micro papules in the center that coalesce leaving a central atrophy zone. The latter had started in the neonatal stage after the Bacille Calmette-Guérin vaccine. For three years she had evidenced a second smaller lesion in the outer face of the right thigh of similar characteristics and other multiple lesions in the back with the shape of vinous red micro papules. Assessment tests were generally normal, as well as the chest and limbs X-ray. The tuberculin test evidenced a 15 mm induration and smears were negative. The deltoid muscle skin lesion biopsy showed caseous granulomas and molecular techniques diagnosed attenuated Mycobacteriumbovis. Given that diagnose the patient received anti-TB treatment during 10 months, tolerance being good and the lesions improved.


A tuberculose cutânea é uma doença infecciosa crônica e pouco frequente causada pelo Mycobacteriun tuberculosis. Existem várias formas de infecção cutânea, sendo o lúpus vulgar a mais frequente e comum nos países industrializados. As variantes clínicas dependerão da via de entrada do bacilo à pele, do estado imunológico do paciente e do ambiente. No lúpus vulgar, além do M. tuberculosis podem estar implicados o M. bovis e mais raramente o bacilo de Calmette-Guérin. Esta entidade apresenta uma evolução crônica, é progressiva e é rara em crianças. Apresenta-se o caso de uma paciente de sexo feminino com 10 anos que foi diagnosticada com uma forma de tuberculose cutânea denominada lúpus vulgar provocada pelo bacilo de Calmette-Guérin. Caso clínico: paciente de sexo feminino com 10 anos que apresentava lesões cutâneas de diferentes características, com evolução letárgica e assintomática; a maior lesão estava localizada na face externa do deltoide direito sob a forma de placa eritematosa de 20 x 10 cm com bordes sobrelevados apresentando no centro micropápulas que coalescem deixando una zona de atrofia central. Esta lesão começou na etapa neonatal depois da vacinação com o bacilo de Calmette-Guérin. Desde 3 anos apresentava uma segunda lesão menor na face externa da coxa direita com características similares e outras múltiplas no dorso com forma de micropápulas com coloração de manchas em vinho do Porto. Os exames de avaliação geral foram normais, bem como as radiografias de tórax e de membros. O teste da tuberculina mostrou uma induración de 15 mm e as baciloscopias foram negativas. A biopsia da lesão de pele dos deltoides mostrou granulomas caseosos e as técnicas moleculares diagnosticaram Mycobacterium bovis atenuado. Com esse diagnóstico recebeu tratamento antituberculoso por 10 meses com boa tolerância e melhoria das lesões.


Assuntos
Criança , Tuberculose Cutânea/diagnóstico , Lúpus Vulgar/diagnóstico , Vacina BCG/efeitos adversos , Criança
9.
Acta Med Port ; 32(4): 313-316, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31067426

RESUMO

The incidence of tuberculosis has been increasing worldwide. Contrarily, a recent decrease in Portugal has been reported. Cutaneous tuberculosis comprises a low percentage of all cases. We report a 70-year-old female with a 2-month-history of painful, nodular, suppurative lesions in the groin area, bilaterally. Previous history was remarkable for Human Immunodeficiency Virus infection and stage-IIIB cervical cancer. A skin biopsy, stained with periodic acid-Schiff and Fite's stain, polymerase chain reaction on purulent discharge and mycobacterial culture of the skin were performed, leading to the diagnosis of scrofuloderma. Tuberculostatic therapy was initiated and complete response was observed. This case depicts an uncommon variant of tuberculosis, highlighting the need for awareness of the cutaneous variants of tuberculosis that, although rare, can still present in the clinic today.


Assuntos
Tuberculose Cutânea/diagnóstico , Idoso , Conscientização , Biópsia , Feminino , Virilha , Soropositividade para HIV/diagnóstico , Humanos , Portugal , Pele/patologia , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/patologia
12.
Cutis ; 103(2): E32-E35, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30893397

RESUMO

Cutaneous gummatous tuberculosis (TB) is an uncommon subtype of cutaneous TB that can be seen in notably immunocompromised individuals. We report a case of cutaneous gummatous TB in an immunosuppressed kidney transplant patient. A 60-year-old Cambodian woman presented with fever attributed to recurrent pyelonephritis while on immunosuppressive medications 7 months after kidney transplant. She underwent a bilateral native nephrectomy and was found to have peritoneal nodules, which revealed caseating granulomas and acid-fast bacilli (AFB) consistent with kidney and peritoneal TB. Anti-TB therapy was initiated, resulting in symptom resolution. Subsequently, the Tuberculosis Control Program at the Department of Health (Philadelphia, Pennsylvania) discontinued her medications due to severe thrombocytopenia. During this time, she was closely monitored with blood draws. Approximately 10 weeks after treatment initiation, she noted recurrent fever and a painful, dull red, subcutaneous nodule on the right side of the flank. Biopsy showed an inflammatory infiltrate within the deep dermis indicative of suppurative granulomatous dermatitis. Ziehl-Neelsen stain demonstrated rare AFB within the cytoplasm of macrophages. The patient was restarted on anti-TB therapy resulting in the resolution of her fever and skin lesions. This case illustrates a noteworthy example of a rare form of cutaneous gummatous TB, which should be considered and included in the differential for cutaneous lesions in an immunosuppressed patient.


Assuntos
Antituberculosos/administração & dosagem , Hospedeiro Imunocomprometido , Transplante de Rim , Tuberculose Cutânea/diagnóstico , Feminino , Granuloma/diagnóstico , Granuloma/microbiologia , Humanos , Imunossupressores/administração & dosagem , Pessoa de Meia-Idade , Tuberculose Cutânea/tratamento farmacológico
14.
An Bras Dermatol ; 94(1): 102-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726475

RESUMO

Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis, comprising 1-2% of cases. Caused by Mycobacterium tuberculosis or related strains, it presents a wide range of clinical manifestations, mimicking other chronic dermatoses and leading to delayed diagnosis. A case of scrofuloderma is reported, whose diagnosis and treatment were only made six years after onset of the disease.


Assuntos
Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/patologia , Adulto , Diagnóstico Tardio , Humanos , Masculino , Pele/patologia , Teste Tuberculínico
15.
An. bras. dermatol ; 94(1): 102-104, Jan.-Feb. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-983737

RESUMO

Abstract: Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis, comprising 1-2% of cases. Caused by Mycobacterium tuberculosis or related strains, it presents a wide range of clinical manifestations, mimicking other chronic dermatoses and leading to delayed diagnosis. A case of scrofuloderma is reported, whose diagnosis and treatment were only made six years after onset of the disease.


Assuntos
Humanos , Masculino , Adulto , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/patologia , Pele/patologia , Teste Tuberculínico , Diagnóstico Tardio
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