Clinico-Laboratory Profile of Tuberculides: An Experience at a Tertiary Care Centre from Chandigarh, India.

Background: Tuberculides are characterised by delayed-type of immunologic reactions to Mycobacterium tuberculosis or its products in immuno-competent individuals. We herein describe clinico-epidemiological features and response to treatment in patients with tuberculides from a tertiary care centre from North India. Methods: This was a retrospective analysis of the clinical records of all the cutaneous tuberculosis (TB) patients (year 2000-2019) enrolled in the TB clinic. The patient records fulfilling the diagnostic criteria of tuberculides were considered for analysis. Results: A total of 225 patients attended the tuberculosis clinic; out of this, 34 were diagnosed as tuberculides. Out of these 34 cases, 21 were identified as LS, 2 erythema induratum of Bazin, 1 papulonecrotic tuberculide, and 10 erythema nodosum. History of contact to open cases of TB was present in 15/34 (44.1%) patients. History of BCG vaccination was found in 15/34 (44.1%) patients. The focus of underlying TB could be identified in 20/34 (58.8%) patients. Skin biopsy was performed in all patients. In all patients, the diagnosis was confirmed by clinico-pathological correlation, positive TST, and the underlying focus of TB. All patients received 6 months regimen of anti-tubercular therapy with first-line drugs. Conclusion: In this study, we demonstrated various forms of tuberculides; lichen scrofulosorum was the most common form. We also included erythema nodosum cases also, which responded well to ATT. Observation from our study showed that tuberculides are important cutaneous markers for underlying tuberculosis infection, which helps in early detection of occult tuberculosis and timely management.

Pulmonary Tuberculosis With Left Pleural Effusion and Lichen Scrofulosorum: A First-of-Its-Type Report.

Tuberculosis is prevalent in high-burden countries, but its cutaneous form, tuberculid, is rare and often misdiagnosed. Lichen scrofulosorum, a type of tuberculid, is uncommon and typically affects children and young adults, sometimes alongside other tuberculosis symptoms. Herein, a very rare case of lichen scrofulosorum in a 20-year-old Indian male with an underlying focus of tuberculosis in the lungs and pleura is presented. Prompt treatment after detailed lab work backed by clinical assessment helped in establishing the diagnosis. He was put on antitubercular therapy, which led to a marked improvement in skin and pulmonary lesions. However, he was lost to follow-up.

Tuberculids: A Narrative Review.

Tuberculids are a group of dermatoses with tuberculoid histology and the absence of tubercle bacilli. They are considered to be hypersensitivity reactions to circulating Mycobacterium tuberculosis (M. tb) or its antigens in individuals with good immunity. The objective of the review is to provide a detailed literature review of all available articles on tuberculids in the past 10 years and provide an update on epidemiology, etiopathogenetic mechanisms, clinical manifestations, and treatment. A search was performed on PubMed using the keywords lichen scrofulosorum, papulonecrotic tuberculid, erythema induratum, and erythema nodosum tuberculosis for all articles, with no restrictions on age, gender, or nationalities. An update on tuberculids, including some new concepts in pathogenesis, atypical presentations, new investigative modalities, and treatments are reviewed.

Acral involvement in lichen scrofulosorum: A diagnostic oddity with distinctive features on dermoscopy.

A commonly underdiagnosed harbinger of visceral tuberculosis, lichen scrofulosorum classically manifests as centripetally located erythematous to violaceous cutaneous papules. Perifollicular and perieccrine tuberculoid granulomas constitute the histologic hallmark. We report a case of lichen scrofulosorum with involvement of the acral areas which is unusual. Also, dermoscopy, which has not yet been widely utilized in this condition gave a novel insights into histopathology in this case.

Cutaneous tuberculosis. Part I: Pathogenesis, classification, and clinical features.

Tuberculosis is an ancient disease that continues to affect an estimated 10 million people per year and is responsible for 1.4 million deaths per year. Additionally, the HIV epidemic and multidrug resistance present challenges to disease control. Cutaneous tuberculosis is an uncommon, often indolent, manifestation of mycobacterial infection that has a varied presentation. Its diagnosis is challenging, as lesions mimic other, more common conditions and microbiological confirmation is often not possible. Cutaneous tuberculosis can be broadly categorized into multibacillary and paucibacillary forms. Approximately one-third of skin tuberculosis is associated with systemic involvement. By recognizing cutaneous tuberculosis early, dermatologists can play an important role in disease control. The first article in this 2-part continuing medical education series describes the latest epidemiology, microbiology, and pathogenesis of tuberculosis. Furthermore, we review the classification, clinical manifestations, common clinical differentials, and systemic involvement that occur in cutaneous tuberculosis.

Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment.

Despite the availability of effective treatment regimens for cutaneous tuberculosis, challenges to disease control result from delayed diagnosis, infection with multidrug-resistant mycobacterial strains, and coinfection with HIV. Delayed diagnosis can be mitigated when dermatologists are sensitized to the clinical signs and symptoms of infection and by the incorporation of appropriate diagnostic tests. All cases of cutaneous tuberculosis should be confirmed with histopathology and culture with or without molecular testing. In each case, a thorough evaluation for systemic involvement is necessary. Mycobacteria may not be isolated from cutaneous tuberculosis lesions and therefore, a trial of antituberculosis treatment may be required to confirm the diagnosis. The second article in this 2-part continuing medical education series describes the sequelae, histopathology, and treatment of tuberculosis.

Lichen scrofulosorum: Cutaneous manifestation of tuberculous lymphadenitis.

Cutaneous tuberculosis (TB) known as tuberculid forms 1%-1.5% of all extrapulmonary manifestation of TB. Tuberculids result from a hypersensitivity reaction to an extracutaneous source of Mycobacterium tuberculosis in individuals with high immunity and can be difficult to diagnose. Lichen scrofulosorum (LS) is a rare form of tuberculid predominantly seen in children and young adults; we report a case of an 8-year-old boy evaluated for fever and mediastinal lymphadenopathy in whom the skin lesions, LS, served as an important clue for the diagnosis of tuberculous lymphadenitis.

NOD2 Mutation-Associated Case with Blau Syndrome Triggered by BCG Vaccination.

We describe a patient who developed multiple granulomatous skin lesions after Bacille de Calmette et Guérin (BCG) vaccination without significant effect by topical corticosteroid, followed by painless cystic tumors on the bilateral knees and hands and inflammatory changes on ophthalmologic examination. A functional mutation in NOD2 was detected by a genetic analysis, and he was diagnosed as sporadic Blau syndrome. Since NOD2 acts as a sensor for the BCG component, it is possible that BCG vaccination may trigger granuloma formation in Blau syndrome patients with such genetic background.

A Rare Case Presentation of Spina Ventosa Associated with Lichen Scrofulosorum and A Tuberculoma.

Introduction: Tuberculosis (TB) can present in different ways and should be regarded as one of the possible diagnoses of several bony, cutaneous, and neurological pathologies. Case Report: We present a case report of a 13-year-old female, who presented with swelling of the left index finger, then diagnosed to have Pulmonary and extra-pulmonary TB (Spina Ventosa, Lichen scrofulosorum, cervical lymphadenitis, mediastinal lymphadenopathy, and a frontal lobe Tuberculoma). We further discuss its features and management. The patient's condition improved on the initiation of Anti Koch's Treatment, and debridement of the left index finger's lesion. Conclusion: Patients can be asymptomatic with widespread TB. As TB can present in different ways, when examining a patient, always consider the possibility of multiple organs being involved.

Unusual presentations of cutaneous tuberculosis.

Cutaneous tuberculosis occurs in 1-2% of world cases of tuberculosis and more common in tropical countries. It presents with different clinical forms. Unusual clinical presentations are not uncommon and awareness of these will help in suspecting and managing these patients successfully. Lupus pernio like lupus vulgaris, tuberculosis of glans penis and lichen scrofulosorum on the distal parts of limbs are presented here because of their unusual clinical presentation.

Seven cases of infant lichen scrofulosorum related to bacillus Calmette-Guérin vaccination / 中华皮肤科杂志

Objective To investigate the etiology,clinical manifestations,diagnosis and outcomes of lichen scrofulosorum (LS).Methods Clinical data collected from 7 infants with LS,who visited Department of Dermatology,Tianjin Children's Hospital between 2010 and 2018,were analyzed retrospectively,and the etiology,clinical manifestations,diagnosis,development and outcomes of LS were investigated.Results All the 7 infants developed LS after bacillus Calmette-Guérin (BCG)vaccination,and the clinical manifestations of LS were reddish or hazel papules mainly distributed on the trunk with small scales attached to the surface.No abnormal laboratory examination results were observed.Histopathological examination showed granuloma in the dennis.Without any treatment,all rashes of the 7 patients disappeared within 6 months,and no scar or hyperpigmentation remained.Conclusions Infant LS usually appears 2-3 months after BCG vaccination,clinically presents as papules mostly on the trunk,pathologically characterized as granuloma in the dermis,and can heal spontaneously.

A Case of Lichen Scrofulosorum Occurring in a Patient with AIDS / 대한피부과학회지

No abstract available.

A Case of Lichen Scrofulosorum Occurring in a Patient with AIDS / 대한피부과학회지

No abstract available.

Lichen scrofulosorum: A diagnosis overlooked.

Lichen scrofulosorum, also known as "tuberculosis cutis lichenoides," is a rare tuberculid that presents as a lichenoid eruption of minute papules in children and adolescents with tuberculosis. The lesions are usually asymptomatic, closely grouped, skin-colored to reddish-brown papules, often perifollicular, and are mainly found on the abdomen, chest, back, and proximal parts of the limbs. The eruption is usually associated with a strongly positive tuberculin reaction. Diagnosis of these lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. We report a case of lichen scrofulosorum in an adult male without any focus of tuberculosis. He responded promptly to antitubercular therapy with complete clearance of lesions in one month.

Lichen Scrofulosorum Occurring in Association with Tuberculous Salpingitis / 대한피부과학회지

Lichen scrofulosorum is a rare disease of children and young adults. The cutaneous lesions of LS are typically symptomless, tiny, flat-topped papular eruptions, which are skin-colored and follicular in distribution. Histopathologically, LS shows perifollicular noncaseating granulomas. LS is usually associated with extrapulmonary tuberculosis, especially of the lymph nodes and bones, and has also been reported in patients with pulmonary tuberculosis. However, the underlying focus is not always obvious, at the time of rash development, and could be diagnosed after the development of LS. Here, we describe a 43-year-old Korean woman with LS who developed tuberculous salpingitis 8 months later.

Coexistence of papulonecrotic tuberculide with lichen scrofulosorum.

Tuberculides, the supposedly immunologic reactions to the products of dead Mycobacterium tuberculosis bacilli deposited in the skin from distant foci of tubercular infection, are presently considered to be of two types-papulonecrotic tuberculide and lichen scrofulosorum. Simultaneous occurrence of both the types in the same patient is very rare. We report the case of an adult male without any known internal tubercular focus who showed two types of skin lesions, clinically typical and histopathologically consistent with the diagnoses of papulonecrotic tuberculide and lichen scrofulosorum, occurring simultaneously. Polymerase chain reaction showed the presence of Mycobacterium tuberculosis DNA in papulonecrotic tuberculide type of lesion, and both types of lesions responded promptly to anti-tubercular drugs.

A Case of Lichen Scrofulosorum Developing after BCG Vaccination / 대한피부과학회지

Tuberculid is thought to develop as a hypersensitive immunologic reaction in the skin to an occult internal focus of tuberculosis. Lichen scrofulosorum (LS) is a rare tuberculid, which usually develops in children and young adults. Rarely, lichen scrofulosorum can be caused by Bacillus Calmette-Guerin (BCG) vaccination. With the increasing use of BCG inoculation, several complications have been reported. However, there have been no reports of lichen scrofulosorum following BCG vaccination in the Korean literature. We report a case of lichen scrofulosorum developing after BCG vaccination.

Lichen scrofulosorum: an important marker of occult tuberculosis.

Lichen scrofulosorum is a tuberculid that is usually seen in children or young adults. Although a rare occurrence, this tuberculid is an important marker of occult tuberculosis, which may not be detected otherwise. We report here a case of lichen scrofulosorum in a ten year-old boy with typical grouped lichenoid papules on the trunk associated with axillary tuberculous lymphadenitis.