Disseminated tuberculosis associated with reactive arthritis of Poncet in an immunocompetent patient

Abstract Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.

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.

Tuberculosis cutánea: rasgos clínicos, histopatológicos y epidemiológicos en un Hospital General de Trujillo, Perú / Cutaneous tuberculosis: clinical, histopathologic and epidemiologic features in a Trujillo, Perú´s general hospital

La tuberculosis continúa siendo un problema de salud pública de primer orden, a escala mundial. Las formas cutáneas de la tuberculosis son poco comunes, constituyen 1 por ciento de los casos de tuberculosis extrapulmonar e involucra entre 0,015 y 0,1 por ciento de las consultas dermatológicas. Su incidencia refleja la relación existente con la situación económica y demográfica. Objetivo: Determinar las características epidemiológicas, clínicas e histológicas de los pacientes con tuberculosis cutánea (TC) atendidos en el servicio de Dermatología del Hospital Regional Docente de Trujillo (HDRT).Pacientes y Métodos: Se consideró para la población en estudio todos los pacientes con tuberculosis cutánea atendidos, desde el 1 de enero de 1995 hasta el 31 de diciembre de 2000. Para el diagnóstico de tuberculosis cutánea, se consideró los criterios clínico e histopatológico, debido a las limitaciones de las tinciones de Ziehl Neelsen o el cultivo en medio de Lowenstein Jensen. La información fue recolectada en una ficha clínica diseñada para tal fin, y se revisó las láminas correspondientes a cada caso, en el Servicio de Anatomía Patológica, cuyos datos fueron consignados también en una hoja de encuesta histopatológica. Para la determinación de las formas clínicas de tuberculosis cutánea, se usó la clasificación propuesta por Beyt y col., modificada por Savin y Tappeiner y Wolf, la misma que se basa en la vía de infección; en esta se incluye las tuberculides. Para el análisis e interpretación de la información del presente trabajo, se utilizó la estadística descriptiva, realizando el diagnóstico situacional. Se presenta tablas, gráficas, con sus respectivos promedios y desviaciones estándares. Resultados: En el lapso de 6 años, se encontró 36 pacientes con TC, de 22 868 pacientes atendidos en el HRDT, alcanzando una incidencia de 0,16 por ciento y una frecuencia mensual de 0,5 casos, entre 1995 y 2000, con un franco predominio del sexo femenino...

Tuberculosis continues being a first order public health world problem. The cutaneous forms of tuberculosis are uncommon and represent 1% of extra pulmonary tuberculosis cases and involve 0,015 to 0,1% of the dermatologic consultations.Its incidence reflects the existing relation with the local economical and demographic situation. Objective: To determine characteristics, epidemiology, clinics and histology of patients with cutaneous tuberculosis attended at the Dermatology service of Trujillo’s Teaching Regional Hospital.Patients and Methods:Patients with cutaneous tuberculosis attended from January 1995 through December 31, 2000 were considered. Criteria for cutaneous tuberculosis diagnosis were clinical and histopathological. The information was collected in a designed clinical card and histology corresponding to each case was reviewed and registered. For cutaneous tuberculosis clinical varieties determination we used the classification proposed by Beyt and collaborators and modified by Savin, Tappeiner and Wolff, classification based on the infection route, that includes tuberculids. For data analysis and interpretation we used descriptive statistics, showing the results in tables, graphs and corresponding averages.Results:Thirty-six patients with cutaneous tuberculosis were seen in six years; 22 868 patients were attended at Trujillo’s Teaching Regional Hospital at the same period with 0,16% incidence of cutaneous tuberculosis and a monthly frequency of 0,5 cases, predominating the female sex (63,9%). According to clinical varieties, erithema induratum represented 41,7%, scrofuloderm 33,3%, lupus vulgaris 11,1%, verucous cutaneous tuberculosis 5,6% and erithema nodosus 8,3%. No age was free from affectation, and the age group range between 11 and 40 years represented 72,2%. Lesions topography was mainly in inferior extremities (erithema induratum), followed by neck and thorax (scrofuloderm). Almost all lesions were unilateral, with the exception of erithema nodosus that was bilateral. There was association with other tuberculosis forms in 10 patients, 8 in lungs and 1 osteomyelitis, other with pleural tuberculosis and another with lungs and spine compromise. History of familiar tuberculosis was present in 27,8%. PPD was done in 91,7% of cases and only 84,9% were positive. There was good treatment reponse in all patients. Cutaneous tuberculosis diagnosis was done by skin biopsy in 91,7%. Granulomas with epithelioid cells was confirmed by histology in 100% of cases, giant lymphocytes in 96,6%, giant cells in 75,9%, plasma cells in 6,9% and caseous necrosis in 24,1%.Conclusion:Cutaneous tuberculosis had a frequency of 0,5% cases per month with an incidence of 0,16% at Trujillo’s Teaching Regional Hospital, with predominance of erithema induratum. The tuberculids-like erithema nodosum must be considered specific unless contrary proof is available.

Tubercúlides: revisão sobre tema polêmico / Tuberculids: revision on controversial theme

Tubercúlides representam uma forma de reação de hipersensibilidade a antígenos bacterianos liberados de um foco de infecção distante. A maioria dos pacientes é caracterizada por apresentar PPD forte reator e evidência de passado de tuberculose pulmonar e(ou) contactante. O tratamento é baseado na terapia de dessensibilização com tuberculina, drogas antituberculosas e corticóides.

Tuberculids represent a form of hypersensitivity reaction to tuberculosis antigens released from a distant focus of infection. Most of patients are characterized by displaying a markedly positive Mantoux skin test and evidence of past tuberculosis infection or contacts of patient with tuberculosis. The treatment is based on tuberculin desensitizing therapy, antituberculous drugs and corticosteroids.