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2.
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
3.
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
4.
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
5.
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
7.
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
10.
J Med Case Rep ; 12(1): 371, 2018 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-30554566

RESUMO

BACKGROUND: Cutaneous tuberculosis represents only 1-2% of extrapulmonary forms of tuberculosis. Scrofuloderma is an endogenous form of cutaneous tuberculosis and can present as isolated or coexist with pulmonary and disseminated forms of tuberculosis. Pathologically confirmed scrofuloderma coexisting with disseminated tuberculosis with a good treatment response is presented and discussed. CASE PRESENTATION: A 12-year-old African Ethiopian girl presented with bilateral neck swelling with purulent discharge and skin ulceration of 3 months' duration. Dry cough, low-grade fever, decreased appetite, drenching night sweats, global throbbing headache, and a significant amount of weight loss were also reported. Biopsy of the skin identified scrofuloderma, and Mycobacterium tuberculosis was also identified by Xpert MTB/RIF assay. Cerebrospinal fluid analysis and brain computed tomographic scans showed tuberculous meningitis and tuberculoma. Antituberculosis therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol; prednisolone; pyridoxine; and wound care were provided. The patient was discharged for outpatient directly observed antituberculosis therapy in a nearby health center after acute complications were treated and once the skin lesion had started to dry or heal. CONCLUSIONS: Cutaneous tuberculosis should be considered in a child presenting with a skin lesion or discharge. Cutaneous tuberculosis cases should be investigated for coexisting pulmonary and extrapulmonary forms of tuberculosis. Histopathologic diagnosis should be considered to rule out other skin pathologies and also to prevent delay in treatment. Better tuberculosis prevention strategies, including vaccination scale-up, are warranted.


Assuntos
Anti-Inflamatórios/uso terapêutico , Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Pele/patologia , Tuberculose Cutânea/diagnóstico , Criança , Etambutol/uso terapêutico , Feminino , Humanos , Isoniazida/uso terapêutico , Pescoço/patologia , Prednisolona/uso terapêutico , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Resultado do Tratamento , Tuberculose Cutânea/tratamento farmacológico
11.
Skinmed ; 16(5): 301-303, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30413222

RESUMO

The clinical diagnosis of cutaneous tuberculosis (CT) was based on criteria of reinfection and reactivation. Laboratory tests are mandatory but have limitations, thus demanding continuous innovation. In our study, we took punch biopsies from lesions on 48 patients. Half of these biopsies underwent histopathologic investigation, and the other half were analysed using the BACT Alert 3D system, the Amplified Mycobacterium Tuberculosis Direct Test (AMTDT), and DNA amplification by polymerase chain reaction (PCR) using primers specific for the M. tuberculosis 16SrRNA complex. Patients were given antitubercular therapy for 6 weeks. A positive response was indicative of CT. Histopathology was suggestive, although no acid-fast bacilli could be demonstrated. In vitro culture recovery of M. tuberculosis was possible in six (12.5%); only two (4%) were positive on AMTDT, and 14 (29%) on real-time PCR. Regression of skin lesions was remarkable after antitubercular therapy, irrespective of a laboratory result. AMTDT and real-time PCR are seen to be of low value in the diagnosis of CT. They are limited by high cost, their paucibacillary nature, and technical errors. On comparing has AMTDT and PCR, the latter was found to be superior. High percentages of negative results were also investigated; extensive involvement of skin has yielded positive PCR results, probably due to low immunity and high bacterial load.


Assuntos
Antituberculosos/uso terapêutico , DNA Bacteriano/isolamento & purificação , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto Jovem
13.
Rev. Soc. Bras. Clín. Méd ; 16(2): 116-118, 20180000. ilus, tab
Artigo em Português | LILACS | ID: biblio-913373

RESUMO

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)


Assuntos
Humanos , Feminino , Adulto , Tuberculose Cutânea/tratamento farmacológico , Reação em Cadeia da Polimerase/métodos , Mycobacterium tuberculosis , Antituberculosos/uso terapêutico , Testes Cutâneos
15.
Neth J Med ; 76(6): 269-274, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30152403

RESUMO

Non-tuberculous mycobacteria are a known cause of skin and soft tissue infections. However, only too often it takes inordinately long to arrive at the appropriate diagnosis and start treatment. Actively searching for predilection factors, exposure risks and specific clinical clues may speed up the diagnostic process. Deep tissue biopsy cultures are indispensable to determine the species and strain of mycobacterium, with important consequences for treatment. Less well known as a causative agent of prolonged tenosynovitis is Mycobacterium tuberculosis. We present a case series and performed a literature search concerning mycobacterial tenosynovitis.


Assuntos
Antituberculosos/administração & dosagem , Mycobacterium tuberculosis/isolamento & purificação , Micobactérias não Tuberculosas/isolamento & purificação , Infecções dos Tecidos Moles/microbiologia , Tenossinovite/microbiologia , Tuberculose Cutânea/microbiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Amostragem , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/patologia , Tenossinovite/tratamento farmacológico , Tenossinovite/parasitologia , Resultado do Tratamento , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/patologia
16.
Medicine (Baltimore) ; 97(22): e10836, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29851791

RESUMO

RATIONALE: Ulcerative skin tuberculosis (TB) is a rare form of extrapulmonary TB. CASE REPORT: We present a case of a 65-year-old patient with perianal ulcer, which had been present for 1 year. Anamnesis revealed he had been persistently coughing for the same period of time. Histological examination of perianal skin showed necrotizing granulomatous lesions, acid-fast staining in sputum samples was ++++, TB antibody in the blood was positive, TB DNA test was positive, and chest scan that showed secondary pulmonary TB accompanied by possible pulmonary cavity formation in the 2 upper lungs. INTERVENTIONS: Anti-TB therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide for 6 months. The skin ulcer completely healed after 6 months. CONCLUSION: TB should be suspected for nonhealing ulcers. Pertinent studies should be done early during the lesion; finally, TB treatment should be initiated immediately after diagnosis is made.


Assuntos
Fissura Anal/patologia , Tuberculose Cutânea/patologia , Tuberculose Pulmonar/diagnóstico por imagem , Idoso , Antituberculosos/uso terapêutico , Etambutol/administração & dosagem , Etambutol/uso terapêutico , Fissura Anal/tratamento farmacológico , Fissura Anal/microbiologia , Humanos , Isoniazida/administração & dosagem , Isoniazida/uso terapêutico , Masculino , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Pirazinamida/administração & dosagem , Pirazinamida/uso terapêutico , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Escarro/imunologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/microbiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/patologia
17.
Dermatol Ther ; 31(4): e12600, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29687600

RESUMO

Despite the high prevalence of pulmonary tuberculosis worldwide, extrapulmonary tuberculosis especially cutaneous and osteoarticular tuberculosis occurs rarely, both of which are often difficult to be recognized since their symptoms mimic those of many other cutaneous and osteoarticular diseases. Here, we present a rare case of cutaneous tuberculosis potentially accompanied by osteroarticular tuberculosis in a 36-year-old Chinese man who presented with multiple persistent skin ulcers for one year and were nonresponsive to multiple therapeutic approaches. A single anti-tuberculous regimen with rifampicin resulted in healing of all skin lesions and excellent recovery of the general condition.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Rifampina/uso terapêutico , Úlcera Cutânea/tratamento farmacológico , Pele/efeitos dos fármacos , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Osteoarticular/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Adulto , Biópsia , Humanos , Masculino , Pele/microbiologia , Pele/patologia , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/microbiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/microbiologia , Tuberculose Osteoarticular/diagnóstico , Tuberculose Osteoarticular/microbiologia
18.
Pediatr Infect Dis J ; 37(12): e347-e349, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29570177

RESUMO

Tuberculosis (TB) is a severe problem in underdeveloped countries. Cutaneous TB is rare and often goes unrecognized. We report a Pakistani child with multifocal cutaneous and pulmonary TB. Microbiologic diagnosis was obtained when the abscesses were biopsied. Four-drug therapy produced rapid improvement of the lesions. A high level of suspicion must be maintained when evaluating children from countries at risk.


Assuntos
Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Cutânea/diagnóstico , Adolescente , Feminino , Humanos , Pele/microbiologia , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico
20.
Dermatol Online J ; 24(8)2018 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-30677847

RESUMO

An 86-year- old woman with a history of recurrent bronchitis and giant cell arteritis presented for new onset, cyclic and migratory erythematous nodules associated with fatigue and weight loss. Although a systemic vasculitis was initially suspected, elevated inflammatory markers and symptoms persisted despite aggressive corticosteroid therapy. Excisional biopsy of one nodule showed dense suppurative and granulomatous inflammation that was rife with acid-fast bacilli. The patient was urgently admitted for empiric treatment of disseminated mycobacterial infection. Although T-SPOT Tuberculosis testing and direct mycobacterial PCR were negative, mass spectrometry demonstrated Mycobacterium chelonae. The patient was treated with a macrolide and quinolone combination regimen and then discharged to a rehabilitation facility.


Assuntos
Infecções por Micobactéria não Tuberculosa/diagnóstico , Tuberculose Cutânea/diagnóstico , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Eritema/etiologia , Eritema/patologia , Fadiga , Feminino , Humanos , Linezolida/uso terapêutico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/microbiologia , Infecções por Micobactéria não Tuberculosa/patologia , Mycobacterium chelonae , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/microbiologia , Tuberculose Cutânea/patologia , Perda de Peso
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