[A case of cutaneous tuberculosis evolving for 50 years]. / Un cas de tuberculose cutanée évoluant depuis plus de 50 ans.

INTRODUCTION: Tuberculosis is an infection caused by Mycobacterium (M.) tuberculosis. It is rare in France. Clinical presentations vary, making demonstration of the cause of M. Tuberculosis difficult and rendering diagnosis and management difficult. PATIENTS AND METHODS: A 58-year-old man, born in Morocco, consulted for ulceration of the right forefoot that had been present since the age of 3 years. He had previously consulted at several dermatology departments. He had undergone numerous skin biopsies and bacteriological and mycobacteriological cultures but these did not contribute to the diagnosis. Slow extension and oozing were observed over time and resulted in functional disability. Given the evocative clinical aspect and despite further negative screening for mycobacteria, anti-TB quadrotherapy was prescribed and resulted in complete cure of the lesion. DISCUSSION: This case underscores the difficulty of diagnosing cutaneous tuberculosis. Such a diagnosis must be clinically suspected in the presence of long lasting destructive or verrucous skin lesions that fail to heal, even where cultures are negative, and anti-TB therapy should be putatively prescribed.

[Latent-disseminated tuberculosis revealed by atypical skin ulcerations]. / Tuberculose disséminée paucisymptomatique révélée par des ulcérations cutanées atypiques.

INTRODUCTION: Cutaneous tuberculosis (CT) is rare in industrialized countries. Given the clinicopathological polymorphism and the difficulty of isolating the pathogen, diagnosis can be difficult. The condition may be associated with other known locations of the disease or in rare cases, it may be a tell-tale sign, as in our case, in which leg ulcers revealed paucisymptomatic disseminated tuberculosis. OBSERVATION: A 67-year-old man was referred for rapidly extensive ulcers of the right leg contiguous to debilitating arthritis of the knee of unknown aetiology for 18 months. Earlier investigations revealed thymoma and a pulmonary nodule considered to be sarcoidosis. A skin biopsy showed a granulomatous eosinophilic-rich infiltrate and vasculitis of the small vessels. Screening of the skin sample and gastric aspirate for Koch Bacillus (BK) was negative. A diagnosis of sarcoidosis was made. A positive QuantiFERON test eventually led to the correct diagnosis. On further testing of bronchoalveolar fluid and a synovial biopsy, culture for Mycobacterium tuberculosis (MT) was positive. The PET scan showed high metabolism in the prostate, bone, spleen, liver, nodes and heart. The quad- and then dual-antibiotic antitubercular therapies produced a rapid improvement but treatment was continued over 12 months, given the persistence of high metabolism on PET-CT scan and the low blood rifampicin concentration. DISCUSSION: A CT should be considered in the presence of giant-cell granulomas, even in the absence of caseous necrosis, and where both direct examination and culture for the skin are negative. Our case also underlines the importance of an extensive workup to rule out disseminated disease even if the patient is not symptomatic.

[Cutaneous tuberculosis and erythema induratum: a retrospective study of 13 cases in France]. / Tuberculose cutanée et érythème induré de Bazin: étude rétrospective de 13 cas.

BACKGROUND: Tuberculosis is the most common mycobacterial disease in the world. The cutaneous form is rare in low endemic countries. The occurrence of several cutaneous tuberculosis cases in our dermatology department during 2011-2012 led us to investigate whether there was a resurgence of cutaneous tuberculosis in France. The aim was to analyse changes in cutaneous tuberculosis and the related clinical, microbiological and therapeutic data. PATIENTS AND METHODS: We conducted a retrospective study in our hospital between 2005 and 2012 by querying the PMSI database (code: A 18.4). Epidemiological, clinical, paraclinical and therapeutic data were collected. Erythema induratum was regarded as a variety of cutaneous tuberculosis. RESULTS: Thirteen patients presented cutaneous tuberculosis between 2005 and 2012. The most frequent clinical forms were erythema induratum of Bazin (n=6) and scrofuloderma (n=3). Microbiological evidence was provided in only 4 cases. DISCUSSION: Diagnosis is difficult due to the varied clinical forms and to the relatively high frequency of paucibacillary forms. Further, the set of additional examinations is non-specific. In some cases, it is only therapeutic tests that allow diagnosis to be made. The place of new diagnostic tools must be clarified and a universally acceptable definition of erythema induratum devised.

Twenty-nine cases of lupus vulgaris.

UNLABELLED: Cutaneous tuberculosis (TB) is a rare presentation of extrapulmonary TB. Lupus vulgaris (LV) is a common presentation of cutaneous TB. OBJECTIVE: We aimed to describe the epidemiological, clinical, paraclinical, therapeutic, and outcome features of LV in the region of Sfax, Tunisia. PATIENTS AND METHODS: We conducted a retrospective and descriptive study of LV case patients observed at the dermatology department of the Hédi Chaker Hospital (Sfax) over a 34-year period. RESULTS: A total of 88 cutaneous TB case patients were identified during the study period, including 29 patients presenting with LV. All patients had clinical features of the most common presentation of LV. The results of skin biopsies indicated tuberculoid granulomas without caseous necrosis. Patients received TB treatment. LV progressed to squamous cell carcinoma in one patient. CONCLUSION: In Tunisia, endemic country for TB, LV should be considered in patients presenting with an old skin lesion.

Cutaneous tuberculosis in Tunisia.

INTRODUCTION: Tuberculosis is endemic in Tunisia. Pulmonary tuberculosis is the most common presentation in our country. Cutaneous presentations are rare (1-2% of cases). The diagnosis of cutaneous tuberculosis (CT) is difficult. Histological and clinical presentations are polymorphous, many differential diagnoses are available, and it is difficult to isolate Mycobacterium. OBJECTIVE: We had for aim to study the epidemiological and clinical features of CT in Tunisia, and to compare presentations before and after 1990. PATIENTS AND METHODS: We conducted a retrospective study between January 1991 and December 2011, in which we included all cases of CT observed at the Infectious Diseases and Dermatology Units of the Tunis la Rabta Hospital. RESULTS: Hundred and thirty-seven patients were included, with a mean age of 43.8years; 72.3% were female patients. Hundred and fifty locations were observed, most of which on the head and neck. Scrofuloderma was the most frequent presentation, observed in 65% of cases. The diagnosis was confirmed by histology and/or microbiology in 75.8% of cases. The treatment was prescribed for a mean 11.3months, leading to full recovery in most cases. CONCLUSION: CT is still reported in Tunisia. The diagnosis relies mainly on histology. Controlling this mutilating tuberculosis requires a global control of this disease, and especially lymph node location, given the high rate of scrofuloderma.