Cutaneous tuberculosis with uncommon presentation: A case report and review of literature
Keywords:
Tuberculosis, cutaneous tuberculosis, lupus vulgarisAbstract
Tuberculosis is a serious infection that affects many people worldwide, with a recent increasing prevalence especially in high-risk patients, such as HIV infection, intravenous drug abuse, diabetes mellitus, immunosuppressive therapy, malignancies, end-stage renal disease, and and/or with multiple comorbidities. Although the incidence of Cutaneous Tuberculosis (CTB) is rare, it should be considered in patients presenting with atypical skin lesions suggestive of an underlying infectious etiology. Most often TB is an airborne transmissible disease with skin manifestations presenting as a result of hematogenous spread or direct extension from a latent or active foci of infection. However, primary inoculation may occur as a direct introduction of the mycobacterium into the skin or mucosa of a susceptible individual by trauma or injury. Although rare, it is important for clinicians to recognize the many clinical variants of CTB to prevent missed or delayed diagnoses. It is imperative that physicians have a high index of suspicion in order to quickly and effectively diagnose and treat these substantially morbid skin conditions. We report here a case with atypical presentation that we saw in our Out Patient Department (OPD). The aim of this communication is to bring to attention this often overlooked, but definitely curable clinical entity. This case report demonstrates the importance of a proper history and physical examination as well as diligent laboratory and diagnostic testing in determining the etiology of a suspicious and treatment-resistant skin lesion. Prompt consideration leads to a swift diagnosis and proper treatment resulting in high patient satisfaction.References
Lönnroth K, Raviglione M. Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med 2008; 29:481.
James WD, Berger TG, Elston DM. Andrews' Diseases of the Skin Clinical Dermatology, 11th ed, Elsevier, 2011. p.322.
Frankel A, Penrose C, Emer J. Cutaneous Tuberculosis. A Practical Case Report and Review for the Dermatologist. J Clin Aesthet Dermatol 2009; 2(10): 19-27.
Bravo FG, Gotuzzo E. Cutaneous tuberculosis. Clin Dermatol 2007; 25:173.
Kandola P, Meena LS. Extra pulmonary tuberculosis: Overview, manifestations, diagnostic and treatment techniques. Adv Mater Rev 2014; 1: 13.
MacGregor RR. Cutaneous tuberculosis. Clin Dermatol 1995; 13:245.
Michelson HE. The history of lupus vulgaris. J Invest Dermatol 1946; 7: 261.
Dias MF, Bernardes Filho F, Quaresma MV. Update on cutaneous tuberculosis. An Bras Dermatol 2014; 89: 925.
Bhutto AM, Solangi A, Khaskhely NM, et al. Clinical and epidemiological observations of cutaneous tuberculosis in Larkana, Pakistan. Int J Dermatol 2002; 41(3): 159–165.
Barbagallo J, Tager P, Ingleton R, et al. Cutaneous tuberculosis: diagnosis and treatment. Am J Clin Dermatol 2002; 3(5): 319–328.
Lai-Chong JE, Perez A, Tang V, et al. Cutaneous manifestations of tuberculosis. Clin Exp Dermatol 2007; 32(4): 461–466.
Handog EB, Gabriel TG, Pineda RT. Management of cutaneous tuberculosis. Dermatol Ther 2008; 21(3): 154–161.
Vieites B, Suárez-Peñaranda JM, Pérez Del Molino ML, et al. Recovery of Mycobacterium tuberculosis DNA in biopsies of erythema induratum—results in a series of patients using an improved polymerase chain reaction technique. Br J Dermatol 2005; 152(6): 1394–1396.
Rai VM, Shenoi SD, Gowrinath Tuberculous gluteal abscess coexisting with scrofuloderma and tubercular lymphadenitis. Dermatol Online J 2005; 11(3): 14.
National Tuberculosis Controllers Association; Centers for Disease Control and Prevention (CDC) Guidelines for the investigation of contacts of persons with infectious tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Recomm Rep 2005; 54(RR-15): 1–47.
API Consensus Expert Committee. API TB Consensus Guidelines 2006: Management of pulmonary tuberculosis, extra-pulmonary tuberculosis and tuberculosis in special situations. J Assoc Physicians India. 2006; 54: 219–234.
Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med 2000; 161(4 Pt 1): 1376–1395.
Pai M. The accuracy and reliability of nucleic acid amplification tests in the diagnosis of tuberculosis. Natl Med J India 2004; 17(5): 233–236.
Sun YS, Wen JM, Lü WX, et al. Comparison study on polymerase chain reaction (PCR) and standard culture technique in detecting mycobacterium tuberculosis to diagnose of joint tuberculosis. Zhongguo Gu Shang 2009; 22(7): 504–506.
Blomberg B, Fourie B. Fixed-dose combination drugs for tuberculosis: application in standardised treatment regimens. Drugs 2003; 63(6): 535–553.
Agada FO, Sharma R, Makura ZG. Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck abscess. Ear Nose Throat J 2006; 85(1): 60-2.
Saritha M, Parveen BA, Anandan V, Priyavathani MR and Tharini KG . Atypical forms of lupus vulgaris – a case series. Int J Dermatol 2009; 8(2): Version of Record online.
Sehgal VN1, Sharma S, Verma P, Pahwa M, Mendiratta V. Disseminated cutaneous tuberculosis: an atypical presentation of reinfection (secondary) tuberculosis in an immunocompetent individual. Am J Dermatopathol 2013; 35(7): e128-30. doi: 10.1097/DAD.0b013e31820a19c9.