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Cutaneous tuberculosis in children and adolescents: a
clinicohistological study.J
Eur Acad Dermatol Venereol. 2007 Jan;21(1):40-7.
BACKGROUND AND
OBJECTIVES: Resurgence of tuberculosis (TB) in the era of human
immunodeficiency virus (HIV) has rejuvenated the interest in this
global health problem. Cutaneous TB, an important extra-pulmonary
form in children, is commonly seen in our dermatological practice.
As detection of acid-fast bacillus (AFB) on smear or culture is not
always positive, histopathology is necessary to help in diagnosing
and classifying the variants of skin TB. The current study was
conducted to analyse the clinicopathological characteristics of
cutaneous TB in children and adolescents. MATERIALS AND METHODS:
This prospective study included 103 patients (age<19 years). A
detailed history and clinical examination was followed by complete
investigative work up including fine needle aspiration cytology and
culture. Histopathological evaluation was performed specifically
noting the epidermal and dermal features. The patients were followed
up regularly for one year after the start of treatment. RESULTS: The
different patterns of cutaneous TB seen were, scrofuloderma 38
(36.9%), lichen scrofulosorum 34 (33%), lupus vulgaris 22 (21.3%),
TB verrucosa cutis 4 (3.9%), papulonecrotic tuberculid 4 (3.9%) and
erythema nodosum 3 (2.9%). Systemic associations were seen in 55
(53.4%) patients, namely TB lymphadenitis in 30 (29.2%), pulmonary
TB in 13 (12.6%), abdominal TB in 6 (5.8%) and TB arthritis in 6
(5.8%). The histopathological corroboration of clinical diagnosis
was seen in 65.7% of cases of scrofulodermas, 72.7% of cases of
lupus vulgaris and 67.6% of cases of lichen scrofulosorum.
CONCLUSIONS: A large spectrum of clinical patterns and histological
characteristics of cutaneous TB exists in children. Lichen
scrofulosorum is more commonly seen in comparison to adults.
Systemic involvement was a feature in a major proportion of our
patients.
The role of fine-needle aspiration cytology and Ziehl Neelsen
staining in the diagnosis of cutaneous tuberculosis.Diagn
Cytopathol. 2006 Dec;34(12):826-9.
The present
study highlights the role of fine-needle aspiration cytology (FNAC)
and Ziehl Neelsen (ZN) staining in diagnosis of cutaneous
tuberculosis and correlates the cytomorphological features with
histopathology.FNAC and biopsy was performed on 30 cases of
cutaneous tuberculosis and along with the routine stains, ZN and
periodic acid Schiffs staining was carried out in all cases.On
cytology, out of 9 cases of lupus vulgaris, 89% showed cohesive
epithelioid cell granulomas with or without chronic inflammatory
infiltrate; however, acid fast bacilli (AFB) could be demonstrated
only in 22.2% on cytology while none on histopathology. Of 19 cases
diagnosed as Scrofuloderma, 79% showed caseation necrosis with or
without granulomas, 10.5% revealed granulomas with acute
inflammatory infiltrates. AFB was demonstrated in 78.9% cases on
cytology when compared with 15.8% on histopathology. No conclusion
could be drawn in one case each of TBVC and lichen
scrofulosorum.Hence, correlating cytomorphological patterns with
clinical presentations often yields diagnostic information in cases
of cutaneous tuberculosis and frequently obviates the need for
biopsy especially in cases of scrofuloderma.
Comprehensive findings on clinical, bacteriological,
histopathological and therapeutic aspects of cutaneous tuberculosis.Trop
Med Int Health. 2006 Oct;11(10):1521-8.
OBJECTIVE: To
define the bacteriological and histological correlates of the three
predominant clinical forms of cutaneous tuberculosis and to evaluate
the efficacy of a 9-month daily regimen containing rifampicin and
isoniazid. METHODS: In the dermatological clinics of two major
teaching hospitals in Chennai, 213 patients with suspected clinical
manifestations of cutaneous tuberculosis underwent examination and a
skin biopsy for bacteriological and histological tests. They were
treated with a daily regimen of rifampicin and isoniazid for 9
months and follow-up for 3 years. RESULTS: Bacteriological and/or
histological confirmation of tuberculosis was obtained in 88% of the
cases. Lupus vulgaris lesions were seen mainly in the extremities
and verrucosa cutis occurred predominantly on the sole and foot,
while the cervical and axillary regions were the commonest sites for
scrofuloderma. Ninety-two per cent of the patients showed resolution
of the lesions within the first 6 months of chemotherapy; 1% failed
to respond to this regimen. There was no relapse in any of the cases
during the follow-up period of 3 years. CONCLUSIONS: Clinical
findings were adequate to identify major forms of cutaneous
tuberculosis as evidenced by bacteriological and histopathological
examination. A daily regimen of rifampicin and isoniazid for 9
months was effective in treating cutaneous tuberculosis.
Rapidly developing giant sized lupus vulgaris on the chest
associated with bilateral scrofuloderma on the neck.J
Dermatol. 2006 Jul;33(7):481-5.
Lupus vulgaris
and scrofuloderma are the opposite poles of cutaneous tuberculosis.
Lupus vulgaris of a giant size and scrofuloderma in the vicinity of
this lesion were both present in a 70-year-old female patient. The
purified protein derivative of tuberculin (PPD) skin test was
strongly positive. In histopathological examination, granulomatous
infiltration without caseation necrosis was seen in the dermis. The
patient was treated with a four-drug therapy consisting of
pyrazinamide (25 mg/kg), isoniazid (5 mg/kg), rifampin (10 mg/kg)
and ethambutol (15 mg/kg) daily for 2 months, followed by dual
therapy with isoniazid and rifampin for 6 months. Her cutaneous
lesions significantly regressed after 4 months, leaving keloid
scars.
Psoriasiform lupus vulgaris with 30 years duration.Scand
J Infect Dis. 2006;38(6-7):556-8.
Lupus vulgaris
is a progressive form of cutaneous tuberculosis occurring in a
person with a moderate to high degree of immunity. It is the most
common type of cutaneous tuberculosis. Lupus vulgaris can be
mimicked by several other skin conditions, and a 69-y-old female is
described with an extremely long history of extensive infiltrative
skin lesions with abundant scaling. The lesions were localized on
the right arm and forearm, and on the right lateral surface of the
chest. The diascopic test was positive. Moreover, a large atrophic
scar was seen in the region of right cubital fossa resulting in
contracture of the right elbow joint. The histopathology strongly
suggested the diagnosis of tuberculosis. The final diagnosis of
tuberculosis was confirmed by PCR examination. A
polychemotherapeutic regimen (ethambutol 1250 mg/d, rifampicin 600
mg/d and isoniazid 300 mg/d) was successfully employed for the
treatment of skin lesions.
Lupus
vulgaris--a case diagnosed more than 20 years after onset.
J Dtsch Dermatol Ges. 2006 Nov;4(11):958-60
A
47-year-old Turkish woman developed an erythematous scaly plaque on
her thigh over 20 years. Cutaneous sarcoidosis had been diagnosed
eight years previously on a skin biopsy. We confirmed Mycobacterium
tuberculosis infection by polymerase chain reaction and cultivation
of the causative organism from lesional skin. After several months
of antituberculous treatment with isoniazid, rifampicin, ethambutol
and pyrazinamide, the lesion resolved
Lupus vulgaris
developing at the site of misdiagnosed scrofuloderma.J
Eur Acad Dermatol Venereol. 2003 May;17(3):313-5
Cutaneous
tuberculosis is a rare form of extrapulmonary tuberculosis primarily
occurring in developing countries. The recent increase in the
incidence of tuberculosis, especially due to human immunodeficiency
virus (HIV) infections, has led to a resurgence of extrapulmonary
forms of this disease. We describe a case of lupus vulgaris in a
33-year-old woman who had a 5-year history of a slowly growing
plaque on her neck. The lesion was located at the site of surgery
repairing the scar resulting from the incision of a subcutaneous
abscess during childhood. This lesion was misdiagnosed as bacterial
abscess. Histopathologic examination of the plaque revealed non-caseating
tuberculoid granulomas consisting of lymphocytes, epithelioid and
giant cells. Staining for acid-fast bacilli and culture from
biopsied tissue was negative. Polymerase chain reaction (PCR) for
detection of Mycobacterium tuberculosis DNA, performed on a skin
biopsy specimen, was positive. A diagnosis of lupus vulgaris
developing at the site of a previous misdiagnosed scrofuloderma was
made. Conventional antitubercular therapy with rifampicin, isoniazid
and ethambutol was administered for 6 months, resulting in
resolution of the lesion.
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