Case Report: Tuberculosis Verrucosa Cutis That Mimics Atypical Mycobacterium Cutaneous Infection

Abstract

Tuberculosis verrucosa cutis (TBVC) is a rare diagnosis, which often underdiagnosed and was delayed for treatment. Case: We present a case of TBVC of a twenty-eight-year-old man with complain of a painless verrucous nodule coaslesced from tiny nodules, that sometimes bleed. The patient had history of pulmonary TB contact from his friend, but symptoms, laboratory tests (complete blood count, erythrocyte sedimentation rate, transaminase, urea, and creatinine), and lung radiograph were unremarkable. The patient had no history of chronic ilness, vaccination history was completed. histopathology result showed small foci containing epithelioid cells that surrounded granuloma with suggestive caseous necrosis with no sign of malignancy and positive acid fast bacilli in paraffin section. The patient was treated with first line antituberculous drugs regimen, that includes isoniazid, rifampicin, ethambutol, and pirazinamid. After 6 months, the lesion improved significantly and the patient did not feel any pain or bleed in the lesion. There was no recurrence on follow up 5 months post therapy. Discussion: The major risk factors for development of cutaneous TB are increased exposure to the source of infection. Diagnosis of TBVC lies in identifying the presence of etiology either by histopathology, PCR, or other methods with various sensitivity and specificity. Conclusion: Cutaneous infection of TB might present in various manifestation with multiple differentials and multiple diagnostic modalities that vary in diagnostic accuracy. The trial of TB therapy may be justified and diagnosed based on the improvement after therapy.