Paracoccidioidomicosis crónica multifocal con compromiso perioral y laríngeo en un paciente inmunocompetente: reporte de un caso / Chronic multifocal paracoccidioidomycosis with perioral and laryngeal involvement in an immunocompetent patient: case report

Introducción: la paracoccidioidomicosis es una micosis endémica en áreas tropicales de Suramérica y Centroamérica. 50 % de los pacientes tiene afectación de las membranas mucosas, y la mucosa laríngea se afecta en 22 %-43 % de los casos. Caso clínico: se presenta un caso ilustrativo de un paciente con paracoccidioidomicosis y afectación de la mucosa oral y laríngea con curso clínico sugestivo de tuberculosis diseminada. Discusión: el compromiso mucoso se presenta en 50 % pacientes con paracoccidioidomicosis, mientras que la afectación laríngea se da en 22 %-43 % de los pacientes. En la mayoría de los casos, las lesiones laríngeas se observan como masas granulomatosas con una superficie hemorrágica y se asocian con disfonía, por lo que son difíciles de diferenciar de una tuberculosis laríngea. Conclusión: la afectación laríngea en pacientes con paracoccidioidomicosis es frecuente y tiene curso clínico similar al de la tuberculosis, e implica un reto diagnóstico.

Introduction: Paracoccidioidomycosis is a mycosis endemic in tropical areas of South America and Central America. 50% of patients have mucous membrane in-volvement and the laryngeal mucosa is affected in 22-43% of cases. Case report: We present an illustrative case of a patient with Paracoccidioidomycosis with in-volvement of the oral and laryngeal mucosa with a clinical course suggestive of disseminated tuberculosis. Discussion: Mucosal involvement occurs in half of the patients with Paracoccidioidomycosis, while laryngeal involvement occurs in 22-43% of patients. In most cases, laryngeal lesions are observed as granulomatous masses with a hemorrhagic surface and are associated with dysphonia, making them difficult to differentiate from laryngeal tuberculosis. Conclusion: Laryngeal invol-vement in patients with Paracoccidioidomycosis is frequent and has a clinical course similar to that of tuberculosis, implying a diagnostic challenge.

Scrofuloderma and tuberculous gumma in a young Filipino adult: A rare presentation of multifocal tuberculosis

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Cutaneous involvement is relatively uncommon representing a small fraction (1-2%) of the localizations of extrapulmonary tuberculosis. Cutaneous TB presents with several clinical forms, wherein one of the most common is scrofuloderma resulting from the direct extension of a tuberculous focus from a deeper structure such as the lymph node into the overlying skin. Tuberculous gumma is a rare form which occurs due to hematogenous spread of the TB bacilli. Although presenting with a wide clinical spectrum, it is believed that the association of different morphologies as well as numerous lesions and sites of cutaneous TB in a same patient is very rare.</p><p style="text-align: justify;"><strong>CASE REPORT:</strong> This is a case of a 20-year-old Filipino male presented with a fi ve-month history of several progressive cutaneous lesions initially presenting as subcutaneous nodules evolving into well-demarcated suppurative painless ulcers which were unresponsive to topical antibiotic. Skin punch biopsy from the medial malleolar area of the right foot revealed dilated blood vessels with a diffuse inflammatory infiltrate of lymphocytes, histiocytes, and few multinucleated giant cells. Clinical and laboratory findings were consistent with cutaneous tuberculosis. Patient was started on anti-Koch's treatment regimen and presented an excellent response to treatment showing resolution of the skin lesions on the neck and forearms and notable regression of the lesions on the right foot within four (4) months.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This case serves as a reminder that cutaneous tuberculosis can manifest with a wide spectrum of clinical presentation which can mimic diverse dermatological conditions and may present with high rates of negative or equivocal diagnostic testing results. This report highlights the importance of a high index of suspicion in the timely diagnosis and management of tuberculosis in countries wherein tuberculosis remains a significant health burden such as the Philippines.</p><p style="text-align: justify;"><strong>KEYWORDS:</strong> Cutaneous tuberculosis, Scrofuloderma, Tuberculous gumma, Metastatic tuberculous abscess</p>

Non-healing ulcers as an atypical presentation of Lupus Vulgaris in an adult Filipino: A case report

@#Cutaneous tuberculosis (TB) occurs rarely, comprising only approximately 1% of all extrapulmonary TB cases worldwide. This report presents an atypical clinical manifestation of Lupus vulgaris, the most common form of cutaneous TB. Typically, Lupus vulgaris presents as chronic erythematous plaques over the head and neck area. The patient, a 24-year-old male with limited support and financial resources, presented with chronic painful, non-healing ulcerated lesions on his left upper extremity. Diagnostic tests specific to TB infection, including culture, all turned out negative for TB. No improvement in the lesions was noted with antibacterial and antifungal therapies. Clinical course of the condition and histopathologic findings, though non-specific to TB, became the basis for diagnosis and treatment. Patient currently is on the 3rd month of anti-Koch’s treatment with noted gradual improvement in the character and appearance of the lesions. Lupus vulgaris could appear as ulcers and over the extremities though much less common, posing challenges in both diagnosis and treatment. Malignant transformation could develop if left untreated. Thus, careful and thorough examination of the patient and diligent follow-up and re-evaluation of lesions while considering the patient’s values, concerns and financial capacity, were necessary in successfully addressing both the biomedical and psychosocial aspect of the illness.

Cutaneous Tuberculosis in HIV Patient: A Case Report

Summary@#Tuberculosis (TB) is a serious communicable disease of major concern in endemic regions. Cutaneous tuberculosis (CTB), which accounts for less than 1% of all cases, can cause severe infection in susceptible patients. The diagnosis of CTB is challenging as it can present with a multitude of clinical presentations. The diagnosis must be supported by highly sensitive and specific investigations. This paper highlights the susceptibility of immunocompromised patients to the development of CTB and the challenges in making a diagnosis.

Tuberculose cutânea forma escrofuloderma: relato de caso / Scrofuloderma-shaped cutaneous tuberculosis: case report

Introdução: A tuberculose (TB) é uma doença infecciosa causada pela bactéria Mycobacterium tuberculosis, transmitida a partir da via aérea de pacientes com a forma pulmonar ou laríngea, que atinge cerca de 10 milhões de pessoas no mundo por ano. A forma pulmonar é a mais comum, sendo a TB cutânea responsável por 1,5% dos casos. Descrição do caso: Paciente 58 anos, masculino, apresentando síndrome consumptiva e abscessos em flanco direito, região pré-esternal e hemitórax direito há 60 dias, sem febre ou outros sintomas associados. Ao exame, apresentava lesão fibroelástica com aspecto similar a escrofuloderma. Análise histopatológica evidenciou processo inflamatório inespecífico sem sinais de malignidade. Cultura para fungos negativa e houve positivação da cultura para M. tuberculosis. Discussão: A TB cutânea é uma forma de apresentação rara de TB. Sua forma escrofuloderma é a mais observada em países em desenvolvimento. A lesão do escrofuloderma pode ser única ou múltipla. Todo paciente deve ser submetido a pesquisa de foco de TB subjacente, sendo a coexistência com um processo pulmonar ativo relativamente comum. O tratamento da TB cutânea inclui medidas gerais e terapia farmacológica por seis meses. Conclusão: A tuberculose continua sendo uma doença prevalente em todo mundo. O Brasil está entre os 30 países de alta carga de TB, considerados como prioritários no mundo para controle da doença pela OMS. Nesse contexto, reconhecer as formas de apresentação da doença se torna cada vez mais importante. Devemos sempre nos lembrar da TB como um diagnóstico diferencial em nosso meio.

Introduction: Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis, transmitted from the airways of patients with pulmonary or laryngeal forms, which affects around 10 million people worldwide each year. The pulmonary form is the most common, with cutaneous TB responsible for 1.5% of cases. Case description: A 58-year-old male patient, with consumptive syndrome and abscesses on the right flank, pre-sternal region and right hemithorax for 60 days, without fever or other associated symptoms. Upon physical examination, he presented fibroelastic lesion with an aspect similar to scrofuloderma. Histopathological analysis showed a nonspecific inflammatory process with no signs of malignancy. Culture for bacteria and fungi were negatives, while the culture for M. tuberculosis was positive. Discussion: Cutaneous TB is a rare form of TB. Its scrofuloderma form is the most observed in developing countries. The scrofuloderma lesion can be single or multiple. In every single patient, the underlying TB focus survey should be performed, coexistence with an active pulmonary process being relatively common. The cutaneous TB treatment includes general measures and pharmacological therapy for six months. Conclusion: Tuberculosis remains a prevalent disease worldwide. Brazil is among the 30 countries with a high TB load, considered as priorities in the world for the control of the disease by WHO. In this context, recognizing the forms of presentation of the disease becomes increasingly important. We must always remember TB as a differential diagnosis in our environment.

Tuberculosis cutánea: casuística del Servicio de Dermatología del Hospital Nacional / Cutaneous tuberculosis: casuistry of the Dermatology Service of the Hospital Nacional

RESUMEN Introducción: la tuberculosis cutánea no es frecuente y el diagnóstico es difícil por presentar varias formas clínicas, ninguna especifica de la enfermedad, y pueden requerir varios estudios laboratoriales para confirmarlo. Objetivos: realizar una revisión de los casos de tuberculosis cutánea observados en el Servicio de Dermatología del Hospital Nacional en el periodo 1990 - 2019; determinando sus características demográficas, clínicas, laboratoriales y evolutivas. Metodología: estudio retrospectivo, descriptivo y observacional. Resultados: se diagnosticaron 7 casos; 5 hombres y 2 mujeres; con edades que oscilaban de 4 meses a 74 años y 3 eran nativos. Las formas clínicas fueron escrofuloderma y gomosa en 3 casos; verrugosa en 1. Todos tenían compromiso sistémico (pulmonar en 3 casos, óseo en 2 y ganglionar en 4) y también factores de inmunodepresión, predominando la desnutrición. En 3 casos el diagnóstico se confirmó con el cultivo de lesiones de piel que reportó Mycobacterium tuberculosis en 2 y M. bovis en 1. Los otros casos se diagnosticaron por hallazgos de bacilos ácido - alcohol resistentes en piel u otros órganos, anatomía patológica compatible y respuesta al tratamiento. Todos recibieron el tratamiento específico de la enfermedad con buena respuesta a excepción de un caso con inmunodeficiencia severa que falleció. Conclusiones: la tuberculosis cutánea es rara también en nuestro Servicio, pero su diagnóstico representa un desafío importante y además acompaña a afectación sistémica, por lo que el tratamiento debe ser oportuno.

ABSTRACT Introduction: cutaneous tuberculosis is not frequent and the diagnosis is difficult because it presents several clinical forms, none specific of the disease, and may require several laboratory studies to confirm it. Objectives: to carry out a review of the cases of cutaneous tuberculosis observed in the Dermatology Service of Hospital Nacional in the period 1990 - 2019; determining their demographic, clinical, laboratory and evolutionary characteristics. Methodology: retrospective, descriptive and observational study. Results: 7 cases were diagnosed; 5 men and 2 women; with ages ranging from 4 months to 74 years and 3 were native. The clinical forms were scrofuloderma and gummy in 3 cases; warty in 1. All had systemic involvement (lung in 3 cases, bone in 2 and lymph node in 4) and also immunosuppressive factors, predominantly malnutrition. In 3 cases, the diagnosis was confirmed by the culture of skin lesions that reported Mycobacterium tuberculosis in 2 and M. bovis in 1. The other cases were diagnosed by findings of acid-fast bacilli in skin or other organs, compatible pathological anatomy and response to treatment. All received specific treatment for the disease with a good response, except for one case with severe immunodeficiency that died. Conclusions: cutaneous tuberculosis is also rare in our Department, but its diagnosis represents a significant challenge and also accompanies systemic involvement, so treatment must be timely.

Absceso frío tuberculoso. Revisión de la literatura a propósito de cinco casos en Angola / Tuberculous cold abscess. Literature review on five cases in Angola

RESUMEN Introducción: El absceso frío tuberculoso es la forma clínica más frecuente de tuberculosis cutánea. Objetivo: Familiarizar a los médicos generales con las características clínicas del absceso tuberculoso frío para asegurar su diagnóstico y tratamiento específico en la consulta de Cirugía del Hospital General N'gola Kimbanda en Namibe, Angola en 2018. Método: Se revisó la literatura sobre el tema en bases de datos científicas como Medline, PubMed, SciELO, Scopus, Clinical Key, LILACS con los descriptores: tuberculosis extrapulmonar y absceso frío tuberculoso. Resultados: Los pacientes, tres varones y dos hembras, tres adultos y dos infantes, todos desnutridos, con antecedentes de tuberculosis pulmonar y mal de Pott que fueron enviados a consulta con el diagnóstico de lipoma. En todos los casos se diagnosticó absceso frío tuberculoso, 3 de localización lumbar, 1 toracolumbar y 1 lumbosacra confirmados por microbiología y tratados según los protocolos de las especialidades de Cirugía y Neumología. Conclusiones: Es necesario que los estudiantes de Medicina, médicos generales y especialistas que en su desempeño enfrentan a dichos pacientes dentro y fuera de Cuba se empoderen de las características semiológicas del, también llamado, goma tuberculoso, a fin de identificarlo en los pacientes de riesgo y garantizar su tratamiento médico-quirúrgico específico para evitar la discapacidad y mortalidad asociada a esta temida infección que sigue constituyendo un azote social.

ABSTRACT Introduction: Tuberculous cold abscess is the most common clinical form of skin tuberculosis. Objective: To familiarize general physicians with the clinical characteristics of tuberculous cold abscesses to ensure their diagnosis and specific treatment at the Surgery Department of the N'gola Kimbanda General Hospital in Namibe, Angola in 2018. Method: Literature on the subject was reviewed in scientific databases such as Medline, PubMed, SciELO, Scopus, Clinical Key and LILACS with the following descriptors: extrapulmonary tuberculosis and tuberculous cold abscess. Results: The patients, three males and two females, three adults and two infants, all of them malnourished, with a history of pulmonary tuberculosis and Pott's Disease, who were sent for consultation with a diagnosis of lipoma. In all cases, tuberculous cold abscesses were diagnosed, 3 of them in lumbar location, 1 in thoracolumbar and 1 in lumbosacral locations, confirmed by microbiology and treated according to the protocols of the specialties of Surgery and Pneumology. Conclusions: It is necessary that students of Medicine, general physicians and specialists who face these patients inside and outside of Cuba to gain in knowledge with the semiological characteristics of the tuberculous cold abscess, also known as tuberculous gum, in order to identify it in the patients in risk groups, and to guarantee their specific medical-surgical treatment to avoid the disability and mortality associated to this infection that still constitutes a major issue.

Histopathological pattern of cutaneous disorders in tertiary care center in Shahjahanpur district of India

Background: Histopathological examination is most commonly needed and used investigation in dermatology. The main objective of this study is to share our experience with skin lesions from a tertiary health Centre by describing the histopathological patterns of 675 consecutive cases.Methods: The study was retrospective and was conducted in those patients who attended the OPD. A total of 675 cases were sent for histopathological examination. Further they were classified into various histological categories based on the site and pattern of involvement. Inclusion criteria involves all skin biopsies sent for histopathology examination, exclusion criteria was none.Results: Most common histopathological entity was infectious disease with 22.52% cases leading in this study. Out of which Hansen disease is on top with 16.29% which was followed by cutaneous tuberculosis with 3.70% (25) cases. Second most common group was of psoriasiform reactions with 9.77% cases. In this group most common disorder was psoriasis vulgaris with 5.92% (40) cases. Third and fourth most common group were spongiotic dermatitis and lichenoid dermatitis which presented with 9.18% and 9.03% cases with a minimal difference of 1 case.Conclusions: A huge diversity in skin lesions was noticed in our study ranging from nonspecific dermatitis to malignant melanoma conditions. There was a younger age predominance regarding the patient presentation. Hansen’s disease still remains a single entity in India for which skin biopsy are required.

Clinical Profile of Cutaneous Tuberculosis in a Tertiary Care Teaching Hospital in Eastern Bihar

Introduction: Sleep-deprivation is a state of combinedabsence of sleep and extended wakefulness. Notoriouslyknown to be associated with slowing of cognitive processeslike attention, working memory, and executive functions, it isalso a consequence of insomnia which in turn is an infamoussymptom of depression. Depression has adverse effects onsocial functioning, which further shape its course and outcome.Material and Methods: This systematic review is basedon a systematic search of electronic database PubMedand provides an overview of literature defining cognitiveimpairment and depression, followed by their associationswith sleep deprivation, entailing possible mechanisms ofthese inter-relationships along with the networks in the humanbrain which are susceptible or resilient towards the effectsof insufficient sleep. A total of 47 such articles and studiesconsidering all these aspects were reviewed.Results: Reductions in functional MRI signals in thedorsolateral prefrontal cortex in sleep deprivation are thoughtto account for attention deficits. Impaired working memoryseconded by an overall increase in reaction times wereobserved, while scanning efficiency was claimed to remainunaffected,by some authors. Long term potentiation wasseen to decrease due to sleep deprivation. Alterations in theHPA axis, stress and high cortisol levels, low brain-derivedneurotrophic factor levels were also interlinked with bothsleep deprivation and depression.Conclusion: Sleep deprivation interrupts physiologicalfunctions, neurocognitive processes, and worsens depression.Hence sleep for upto six to eight hours each night isrecommended on the lines of this review.

Infección diseminada por Bacilo Calmette-Guérin en un lactante con inmunodeficiencia: reporte de caso / Disseminated infection by Bacillus Calmette-Guérin in an immunodeficient infant: case report

RESUMEN La vacuna Bacillus Calmette-Guerin (BCG) que se administra a los recién nacidos de países con alta incidencia de tuberculosis puede ocasionar reacciones locales hasta infección diseminada en pacientes inmunocomprometidos. Reportamos el caso de un lactante varón de seis meses con antecedente de haber recibido vacuna BCG al nacer, y presentar cuadros infecciosos a repetición, nódulos violáceos blandos en tronco y extremidades con presencia de bacilos ácido alcohol resistentes (BARR) en la histopatología y en cultivo de piel; el estudio molecular reportó la presencia de Micobacterium bovis BCG. En la tomografía se observó opacidades intersticiales en pulmones y en el lavado gástrico se identificó BAAR. El estudio genético del paciente y de la madre reveló la presencia de mutación en el gen IL2RG confirmando el diagnóstico de inmunodeficiencia combinada severa, recibe tratamiento con inmunoglubolina humana y esquema antituberculosis con isoniacida, rifampicina y etambutol. Presentamos el caso por la implicancia en el pronóstico de vida de estos pacientes y por la necesidad de un diagnóstico preciso y oportuno.

ABSTRACT The Bacillus Calmette-Guerin (BCG) vaccine given to newborns in countries with a high incidence of tuberculosis may cause local reactions up to disseminated infection in immunocompromised patients. We report the case of a six-monthold male infant with a history of having received the BCG vaccine at birth, and presenting repeated infectious, soft violet nodules in the trunk and extremities with the presence of acid-alcohol-resistant bacilli (BAAR) in histopathology and skin culture; the molecular study reported the presence of Mycobacterium bovis BCG. In the tomography, interstitial opacities were observed in the lungs and in the gastric lavage BAAR was identified. The genetic study of the patient and the mother revealed the presence of a mutation in the IL2RG gene confirming the diagnosis of severe combined immunodeficiency. Received treatment with human immunoglobulin and anti-tuberculosis scheme with isoniazid, rifampicin, and ethambutol. We present the case because of the implication in the life prognosis of these patients and because of the need for an accurate and timely diagnosis

Histopathological study of dermal granuloma

INTRODUCTION:The objectives of this study were to confirm the diagnosis of clinically suspected dermal granuloma- tous diseases by histopathological examination and by routine and special stains as well as to study the incidence of various types of dermal granulomas.MATERIALS AND METHODS:This study was conducted at the Department of Pathology in collaboration with De- partment of Skin and Venereal disease. A total of 90 cases from outdoor patient department of skin and venereal disease, which were clinically diagnosed as suspected dermal granulomatous diseases, were taken as the study population.RESULTS:In our study, we found that leprosy had the highest incidence (50%), followed by cutaneous tuberculosis (30%) among all dermal granulomatous diseases like syphilis, fungal, granuloma annulare, foreign body, actino- mycosis, and sarcoidosis. Dermal granulomas were most common in middle age between 21 and 40 years of age.CONCLUSION:Histopathology played an important role in the final diagnosis of dermal granulomatous lesions. Most common dermal granulomatous disease was leprosy, followed by cutaneous tuberculosis.

A Case of Tuberculosis Verrucosa Cutis Confirmed by Detection of Mycobacterium tuberculosis DNA Using by Polymerase Chain Reaction / 대한피부과학회지

No abstract available.

Superficial Granulomatous Pyoderma mimicking an infectious process

Introduction@#Superficial granulomatous pyoderma is a rare superficial variant of pyoderma gangrenosum. With clinical and histological features that mimic infectious processes, misdiagnosis is common. This report aims to present a rare, often overlooked disease, highlighting the need for timely histopathologic diagnosis to prevent unnecessary treatment and morbidity.@*Case@#Patient is a 42-year-old female with recurrent painful ulcers on her right leg. Initial histopathology was interpreted as granulomatous dermatitis secondary to cutaneous tuberculosis and was managed with anti-Koch’s regimen for six months. However, the ulcers worsened, which led to right leg amputation. New similar ulcers eventually recurred over the other extremities where repeat biopsy have shown neutrophilic dermatosis with a three-layer granuloma that is distinctive for superficial granulomatous pyoderma. Patient was treated with oral corticosteroids which was effective in controlling the disease.@*Conclusion@#This report documents a rare case of superficial granulomatous pyoderma presenting as non-healing ulcer, previously misdiagnosed and treated with unwarranted surgery and anti-microbials. The awareness of the characteristic clinical and histopathological features is essential for diagnosis so as to provide rapid disease control and avoid potentially aggravating management.

Tuberculosis verrucosa cutis en niños: Presentación de dos casos y revisión de la literatura / Tuberculosis verrucosa cutis in children: Two cases report and review

La tuberculosis cutánea (TBC) representa el 1.5% de todas las formas de TB extrapulmonares. Es una enfermedad proteiforme y su diagnóstico constituye un reto al clínico. La TB verrucosa cutis (TBVC) es una variante clínica paucibacilar, de TBC, donde es infrecuente aislar en medios de cultivos el Mycobacterium tuberculosis. Ocurre en niños previamente sensibilizados e inmunocompetentes que se reinfectan con este bacilo de una fuente exógena, algunas veces de un esputo o secreción de un paciente con TB activa, cuando juega en la tierra. La bacteria penetra a la piel a través de pequeñas abrasiones en zonas expuestas a traumas como lo son rodillas, tobillos o glúteos. La lesión se inicia como un papulonódulo verrucoso asintomático, parecido a una verruga común, que evoluciona a una placa verrucosa . Reportamos 2 casos de TBVC, una niña de 6 años de edad y el segundo, un niño de 10 años de edad ambos de la comarca Guna Yala, un área con alta prevalencia de TB en Panamá. En el segundo caso se logró aislar el M. Tuberculosis en medios de cultivo y demostrarse además por la reacción en cadena de la polimerasa (PCR). La respuesta a la terapia antituberculosa fue exitosa, en ambos casos, con completa regresión de las lesiones a los 2 meses de tratamiento

Cutaneous tuberculosis (CTB) comprises 1.5% of all extrapulmonary TB forms. It is a proteiform disease and its diagnosis represents a challenge to the clinician. TB verrucosa cutis (TBVC) a paucibacillary clinical manifestation of CTB, where routine cultures for Mycobacteriun tuberculosis, are commonly negative. Occurs in children previously sentitized with a moderate to high degree of immunity. It represents an exogenous reinfection of M. tuberculosis, sometimes from a contaminated sputum of a patient with active TB, at sites prone to minor abrasions, such as, knees, ankles or buttocks. The lesion begins as a solitary asymptomatic verrucous papulonodule, similar to a common wart, that evolves to a verrucous plaque. The author report 2 cases of TBVC, a 6 year old girl and the second one, a 10 year old boy, both from Guna Yala, an indigenous region, o the coast of Panama, an area with a high prevalence of TB. In the second case, M. tuberculosis was isolated in routine cultures and reported positive in Polimerase chain reaction (PCR). The antituberculous therapy was successfull in both patients, with complete regression of the lesions after 2 months of treatment

Bilateral “turkey ear” as a cutaneous manifestation of lupus vulgaris

Lupus vulgaris is a common form of cutaneous tuberculosis in China, mostly involving the head and neck region. Turkey ear is a clinically descriptive term, used for a massively enlarged earlobe with bluish-red or violaceous indurated plaques and nodules, which can be a sign of lupus vulgaris. A 47-year-old female presented with edema and reddish ulcerated lesions on both ears which was diagnosed as lupus vulgaris by conventional laboratory investigations and the patient showed good response to antituberculous therapy. Occurrence of turkey ears in lupus pernio (sarcoidosis) should also be mentioned here as this presentation was originally described in this condition. Two case reports of turkey ear have been reported with cutaneous tuberculosis (not bilateral). However, occurrence of bilateral turkey ears in cutaneous tuberculosis has not been described so far in the literature.

Reação em cadeia da polimerase como determinante para o diagnóstico de tuberculose cutânea / Polymerase chain reaction as a cutaneous tuberculosis diagnostic determinant

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)

Tuberculosis cutánea verrugosa / Tuberculosis verrucosa cutis

Resumen La tuberculosis es una infección global, con formas pulmonares y extrapulmonares. La tuberculosis cutánea corresponde a 0.5-2% de todas las formas extrapulmonares; la forma verrugosa abarca 8% de todas las formas cutáneas. Es una lesión localizada, de reinfección exógena o por inoculación externa. Por lo general se manifiesta después de un traumatismo sobre la piel; la mayor parte ocurre sobre los dedos y el dorso de las manos. El diagnóstico definitivo requiere el aislamiento del microorganismo por cultivo o secuenciación por PCR, pero hay alta frecuencia de cultivos negativos, por lo que el diagnóstico se establece con base en la correlación clínico-patológica y la respuesta al tratamiento antifímico. El objetivo de este artículo es comunicar un caso de tuberculosis cutánea verrugosa y diferenciar esta afección dermatológica de la provocada por M. marinum por su gran parecido en la manifestación clínica.

Abstract Tuberculosis is a global infection with pulmonary and extrapulmonary forms. Cutaneous tuberculosis corresponds to 0.5-2% of all extrapulmonary forms. The warty form comprises 8% of all cutaneous forms. It is a localized lesion, of exogenous reinfection or external inoculation. Usually, it occurs after a trauma to the skin; most occurring on the fingers and the back of the hands. The definitive diagnosis requires the isolation of the microorganism by culture or sequencing by PCR, but there is a high frequency of negative cultures, so the diagnosis is made based on clinical-pathological correlation and response to antituberculosis treatment. The aim of this article is to report a case of verrucous cutaneous tuberculosis and differentiate this dermatological entity from that caused by M. marinum because of its similarity in clinical presentation.

Tuberculosis Verrucosa Cutis in an 11-year-old girl: A case report

@#We report a case of an 11-year-old girl who presented with a gradually enlarging verrucous plaque on the left knee for 3 years. Physical examination showed a solitary, slightly erythematous, scaly, verrucous plaque on the left knee measuring about 1.5 cm x 2 cm. Biopsy revealed granulomatous dermatitis consistent with cutaneous tuberculosis. A diagnosis of tuberculosis verrucosa cutis (TBVC) was made and anti-tuberculous therapy was initiated consisting of rifampicin, isoniazid, pyrazinamide and ethambutol for 2 months followed by rifampicin and isoniazid for 4 months. Upon completion of therapy, only a slightly atrophic scar remained, supporting our diagnosis. This report highlights TBVC must be considered in patients with chronic skin lesions in countries with high prevalence of tuberculosis.

Cutaneous tuberculosis and HIV infection at a referral centre in Rio de Janeiro, Brazil

BACKGROUND Cutaneous tuberculosis (CTB) is a rare extrapulmonary form of tuberculosis (TB). Despite the increase in the number of cases of TB and HIV, few cases of CTB have been reported. OBJECTIVE To describe CTB cases among patients with HIV infection from a cohort with tuberculosis. METHODS We describe a series of 15 CTB and HIV cases, based on secondary data from 2000 to 2016. Diagnosis was based on isolation of Mycobacterium tuberculosis in culture or clinical response to anti-tuberculous treatment associated with positive smear or histopathologic findings from affected skin or an adjacent lymph node. FINDINGS Scrofuloderma was present in 12 (80%) patients and solitary gumma in three (20%) patients. One case of scrofuloderma was associated with papulonecrotic tuberculid. Seven (46.6%) patients had pulmonary TB. Diagnosis was based on culture in nine patients (60%). The median CD4 cell count was 262 cells/µL. All patients were cured at the end of treatment (median time 6 months). Three patients presented with immune reconstitution inflammatory syndrome. CONCLUSIONS In this study, CTB associated with HIV infection presented as localised forms or in association with pulmonary TB. In patients with HIV who have subacute and chronic skin lesions, CTB should be considered in differential diagnosis, which may represent a good opportunity for early diagnosis of active TB.

Cutaneous and articular tuberculosis in a renal transplant recipient

Abstract Seven months after undergoing kidney transplantation, a 56-year-old woman presented with papules and ulcers in her right forearm. The patient received antibiotics for 8 months with limited improvement. Eleven months after symptom onset, she presented with acute arthritis in her left knee. Asynovial fluid culture yielded Mycobacterium tuberculosis, and a forearm ulcer biopsy showed granulomatous inflammation. After surgical fistulectomy and 12 months of tuberculosis treatment, she was cured. Chronic cutaneous ulcers and articular manifestations in TB are rare, but they should always be considered in the differential diagnosis for immunosuppressed patients. Surgical intervention and prolonged treatment might be necessary.