Twenty-nine cases of lupus vulgaris.

UNLABELLED: Cutaneous tuberculosis (TB) is a rare presentation of extrapulmonary TB. Lupus vulgaris (LV) is a common presentation of cutaneous TB. OBJECTIVE: We aimed to describe the epidemiological, clinical, paraclinical, therapeutic, and outcome features of LV in the region of Sfax, Tunisia. PATIENTS AND METHODS: We conducted a retrospective and descriptive study of LV case patients observed at the dermatology department of the Hédi Chaker Hospital (Sfax) over a 34-year period. RESULTS: A total of 88 cutaneous TB case patients were identified during the study period, including 29 patients presenting with LV. All patients had clinical features of the most common presentation of LV. The results of skin biopsies indicated tuberculoid granulomas without caseous necrosis. Patients received TB treatment. LV progressed to squamous cell carcinoma in one patient. CONCLUSION: In Tunisia, endemic country for TB, LV should be considered in patients presenting with an old skin lesion.

Two cases of lupus vulgaris in childhood and review of the clinical challenges.

BACKGROUND: Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis (TB) in Europe, nevertheless the overall incidence is low. It constitutes about 1.5% of all extra-pulmonary cases worldwide. A slight raise in TB incidence rates among children was recently registered in Germany, which can be explained by the increased immigration. PATIENTS AND METHODS: We present 2 cases of immigrated children who were diagnosed with Lupus vulagris, both clinically and histopathologically. Although the symptoms and the duration of the skin lesions were very different, both patients had a non-healing skin ulceration.In our cases cultures of the skin biopsy were positive for Mycobacterium tuberculosis and the lesions showed marked improvement in response to antituberculous treatment. In the first patient, it took 6 years between occurrence of skin lesions and final diagnosis. The second patient had an extracutaneous focus, namely abdominal TB. CONCLUSION: We report our experience and emphasize on recent advances in the diagnosis and treatment of paediatric skin TB.

Cutaneous tuberculosis in Tunisia.

INTRODUCTION: Tuberculosis is endemic in Tunisia. Pulmonary tuberculosis is the most common presentation in our country. Cutaneous presentations are rare (1-2% of cases). The diagnosis of cutaneous tuberculosis (CT) is difficult. Histological and clinical presentations are polymorphous, many differential diagnoses are available, and it is difficult to isolate Mycobacterium. OBJECTIVE: We had for aim to study the epidemiological and clinical features of CT in Tunisia, and to compare presentations before and after 1990. PATIENTS AND METHODS: We conducted a retrospective study between January 1991 and December 2011, in which we included all cases of CT observed at the Infectious Diseases and Dermatology Units of the Tunis la Rabta Hospital. RESULTS: Hundred and thirty-seven patients were included, with a mean age of 43.8years; 72.3% were female patients. Hundred and fifty locations were observed, most of which on the head and neck. Scrofuloderma was the most frequent presentation, observed in 65% of cases. The diagnosis was confirmed by histology and/or microbiology in 75.8% of cases. The treatment was prescribed for a mean 11.3months, leading to full recovery in most cases. CONCLUSION: CT is still reported in Tunisia. The diagnosis relies mainly on histology. Controlling this mutilating tuberculosis requires a global control of this disease, and especially lymph node location, given the high rate of scrofuloderma.

Cutaneous tuberculosis in children.

Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis that accounts for 1% to 2% of cases. Childhood skin tuberculosis represents 18% to 82% of all cutaneous tuberculosis cases. Scrofuloderma and lupus vulgaris are the two most common clinical forms in children. An increase in the number of tuberculids, especially lichen scrofulosorum, has been observed in the last several years. Cutaneous tuberculosis in children can be severe and have a protracted course. Multiplicity of lesions and multifocal disseminated involvement in scrofuloderma and lupus vulgaris is common. Scrofuloderma progressing to gummatous lesions (scrofulous gumma) is mostly described in children. Morbidities and deformities are more severe in children.

Atypical forms of lupus vulgaris - a case series.

Atypical presentations of cutaneous tuberculosis are not so uncommon and are frequently overlooked in clinical practice, leading to late diagnosis and increased morbidity. We report three cases of lupus vulgaris with atypical presentations. The cases mimicked other chronic skin lesions like actinomycosis, mycetoma, and so on. Strong clinical suspicion, histopathology, and response to antituberculous treatment led to the diagnosis and all three had excellent response to treatment. Today, when tuberculosis threatens to burst into pandemics again, early diagnosis and treatment are more important than ever for control and prevention of morbidity.

Clinical and epidemiological study of cutaneous tuberculosis in Northern Ethiopia.

BACKGROUND: Tuberculosis is a major public health problem in Ethiopia but cutaneous tuberculosis (CT) has not been documented. OBJECTIVE: This study was conducted to determine its existence and its clinical pattern in Tigray, a northern region of Ethiopia. METHODS: We report 202 cases of CT who attended the Italian Dermatological Centre in the 34-month period between January 2005 and October 2007. The diagnosis was made on a clinical, cytological and histological basis. RESULTS: Clinically, 143 cases of scrofuloderma, 22 of lupus vulgaris, 18 of gumma, 11 of lichen scrofulosorum, 6 of tuberculosis verrucosa cutis and 2 of erythema induratum of Bazin were observed in our department. All patients were aged between 18 months and 69 years, and 49 were paediatric cases. Forty-five were HIV positive. CONCLUSION: The number of CT cases observed in the period of 34 months indicates a high incidence of the disease in the region also in the paediatric age. CT is still underdiagnosed due to the low number of dermatologists as well as the poor life conditions of the population and the traditional belief in magic medicine. The current study may therefore provide some indication about the epidemiology of CT in Ethiopia.

[Cutaneous tuberculosis overview]. / Panorama de la tuberculose cutanée.

Cutaneous tuberculosis is now uncommon in industrial countries despite the rising incidence of extrapulmonary tuberculosis in areas with high prevalence of HIV infection. Nevertheless it is still important to know the multiple clinical manifestations of cutaneous tuberculosis and to be aware of new laboratory diagnostic methods such as polymerization chain reaction gene amplification.

Cutaneous tuberculosis in Hong Kong: a 10-year retrospective study.

BACKGROUND: Cutaneous tuberculosis was once a relatively common skin disease in Hong Kong. Tuberculosis verrucosa cutis was the commonest type. Because the last survey was carried out 25 years ago, it was thought necessary to find out the new incidence and pattern of this important disease in this locality. METHODS: A 10-year (1983-1992) retrospective survey on the epidemiologic and clinicobacteriologic aspects of cutaneous tuberculosis had been done in the public sector of Hong Kong. The records of the confirmed cases were retrieved for statistical analysis. RESULTS: A total of 176 cases are included in the final analysis. This represents 0.066% of all new skin cases seen during the 10-year period. Among these, 79.5% are erythema induratum, 6.3% lupus vulgaris, and 4.5% tuberculosis verrucosa cutis. They are further divided into true cutaneous tuberculosis (14.8%, n = 26) and the tuberculide (85.2%, n = 150). Among the patients with true tuberculosis, 42.3% had lupus vulgaris, 30.8% had tuberculosis verrucosa cutis, and 26.9% had scrofuloderma. Among the tuberculides, erythema induratum accounted for 93.3%. CONCLUSIONS: Cutaneous tuberculosis is now uncommon in Hong Kong. Tuberculosis verrucosa cutis is no longer the commonest type in Hong Kong as described in some textbooks. Erythema induratum is now the most common among the total cases and lupus vulgaris is the most common among the true cutaneous forms of tuberculosis.

An appraisal of epidemiologic, clinical, bacteriologic, histopathologic, and immunologic parameters in cutaneous tuberculosis.

Cutaneous tuberculosis incidence was recorded as 0.15%. Of the 42 patients, 23 had scrofuloderma, 17 lupus vulgaris, and 2 tuberculosis verrucosa cutis. Both men and women were affected by the disease in the second and third decades. Its duration was variable. An affirmative family history was elicited in five scrofuloderma patients. The clinical expression largely conformed to the ritual text. Variation in Mantoux test positivity was unremarkable. The disparity in the demonstration of bacilli in the smear and tissue sections was, however, quite apparent in scrofuloderma. The correlation of different parameters indicates a continuous spectrum, formed at one end by lupus vulgaris, and at another by scrofuloderma. A moderate to strongly positive Mantoux text, enormous lymphocytes in the granuloma, absence of tubercle bacilli, negative culture, and an apparently normal immunoprofile were features of lupus vulgaris; whereas scrofuloderma had a moderately positive Mantoux test, lesser number of lymphocytes in the granuloma, large number of bacilli in tissue smear and/or tissue section, raised levels of immunoglobulins, and a grossly lowered C3 levels. The other variants probably occupy a position in between.

[Lupus vulgaris (tuberculosis cutis luposa). Clinical aspects and therapy past and present]. / Lupus vulgaris (Tuberkulosis cutis luposa/Tcl) Klinik und Therapie einst und jetzt.

In the developed industrial countries, the frequency of tuberculotic diseases of the skin including lupus has decreased to a very low level because of the significant decline of morbidity and mortality, the elimination of Bovine infections, the introduction of BCG vaccination, as well as effective anti-tuberculotic drugs employed for about 30 years. In spite of the very favorable therapeutic results, we have to reckon with the continuance of the present lupus incidence as long as the number of tuberculotic affections in the world is about 20 million, and even in developed industrial countries, the yearly rate of tuberculotic patients amounts to 43 in 100,000 inhabitants. We know that the disease still occurs very frequently in the developing countries of the Far East.