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>

Tuberculosis cutánea en pabellón auricular: reporte de un caso / Cutaneous tuberculosis in ear auricle: a case report

RESUMEN La tuberculosis cutánea representa menos del 2% de todos los casos de la infección por Mycobacterium tuberculosis. Su baja prevalencia, asociada a la amplia variedad en la presentación clínica de las lesiones, dificulta y retrasa el diagnóstico y, por tanto, el inicio del tratamiento. El siguiente es el caso de una paciente de 80 años, con una lesión ulcerada, crónica, en pabellón auricular izquierdo, con evolución tórpida y pobre respuesta al manejo farmacológico instaurado; con biopsia de piel que mostró reacción inflamatoria crónica y presencia de bacilos ácido-alcohol resistentes.

ABSTRACT Cutaneous tuberculosis represents less than 2% of all cases of infection with Mycobacterium tuberculosis. Its low prevalence, associated with a wide variety in clinical presentation of the lesions, hinders and delays the diagnosis and, thus, treatment initiation. The following is the case of an 80-years old, female patient with an ulcerated, chronic lesion in the left ear auricle, with a torpid evolution and poor response to established pharmacological management; with a skin biopsy that showed chronic inflammatory reaction and the presence of acid-fast bacilli.

A Case of Tuberculous Gumma / 대한피부과학회지

Tuberculous gumma is the result of a hematogenous dissemination of tubercle bacilli from a primary focus during a period of lowered resistance. This unusual disease affects undernourished children of low socioeconomic status or patients who are severely immunodepressed by a disease or therapy. A 68-year-old female patient presented with tender fluctuant erythematous nodules over both upper extremities, shoulder, back and buttock. The biopsy specimen from the fluctuant plaque of right forearm revealed granulomatous infiltration composed of Langhans giant cells, epitheloid cells, plasma cells, lymphocytes and neutrophils in the deep dermis. Numerous acid fast bacilli was identified in AFB staining. Mycobacterium tuberculosis DNA was detected by polymerase chain reaction technique in the specimen from the skin lesion. We here present a very unusual case of tuberculous gumma.

A Case of Tuberculous Gumma / 대한피부과학회지

Tuberculous gumma is the result of a hematogenous dissemination of tubercle bacilli from a primary focus during a period of lowered resistance. This unusual disease affects undernourished children of low socioeconomic status or patients who are severely immunodepressed by a disease or therapy. A 68-year-old female patient presented with tender fluctuant erythematous nodules over both upper extremities, shoulder, back and buttock. The biopsy specimen from the fluctuant plaque of right forearm revealed granulomatous infiltration composed of Langhans giant cells, epitheloid cells, plasma cells, lymphocytes and neutrophils in the deep dermis. Numerous acid fast bacilli was identified in AFB staining. Mycobacterium tuberculosis DNA was detected by polymerase chain reaction technique in the specimen from the skin lesion. We here present a very unusual case of tuberculous gumma.