RESUMO
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.
Assuntos
Artrite Reativa/imunologia , Imunocompetência , Hospedeiro Imunocomprometido , Tuberculose Cutânea/imunologia , Tuberculose Cutânea/patologia , Antituberculosos/uso terapêutico , Etambutol/uso terapêutico , Humanos , Isoniazida/uso terapêutico , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/imunologia , Úlcera Cutânea/patologia , Resultado do Tratamento , Tuberculose Cutânea/tratamento farmacológico , Adulto JovemRESUMO
A 63-year-old black female patient with blisters and exulcerations on the face, neck, upper limbs, and subsequent evolution with hypochromic sclerotic areas and alopecia, is reported. Chronic hepatitis C and presence of high levels of porphyrins in urine were demonstrated. There was complete remission with the use of hydroxychloroquine, photoprotection, and treatment of hepatitis. Significant sclerodermoid involvement of the skin as a manifestation of porphyria cutanea tarda secondary to hepatitis C emphasizes the importance of diagnostic suspicion regarding skin manifestation in order to indicate the appropriate therapy, and to minimize the hepatic morbidity.
Assuntos
Hepatite C Crônica/complicações , Hepatite C Crônica/patologia , Porfiria Cutânea Tardia/etiologia , Porfiria Cutânea Tardia/patologia , Esclerodermia Localizada/etiologia , Esclerodermia Localizada/patologia , Alopecia/etiologia , Feminino , Hepatite C Crônica/terapia , Humanos , Pessoa de Meia-Idade , Porfiria Cutânea Tardia/terapia , Esclerodermia Localizada/terapia , Resultado do TratamentoRESUMO
Abstract: A 63-year-old black female patient with blisters and exulcerations on the face, neck, upper limbs, and subsequent evolution with hypochromic sclerotic areas and alopecia, is reported. Chronic hepatitis C and presence of high levels of porphyrins in urine were demonstrated. There was complete remission with the use of hydroxychloroquine, photoprotection, and treatment of hepatitis. Significant sclerodermoid involvement of the skin as a manifestation of porphyria cutanea tarda secondary to hepatitis C emphasizes the importance of diagnostic suspicion regarding skin manifestation in order to indicate the appropriate therapy, and to minimize the hepatic morbidity.
