The picture of cutaneous tuberculosis today: New diverse clinical manifestations in the absence of the old lupus vulgaris in a series of 72 patients
Abstract
Background Lupus vulgaris as the main picture of the old cutaneous tuberculosis is no more existing at the time being but replaced by different and diverse cutaneous clinical features that can mimic other skin diseases. Objective To record all patients with skin tuberculosis and to do full clinical and histopathological evaluation. Methods This is case series descriptive study where all patients with cutaneous tuberculosis were recorded during the period from 2015-2021 years. Full demographic features were recorded and full clinical assessment was carried out. Classifications of clinical presentations were done. Skin biopsies for histopathological examination were performed. Tuberculin testing was done as confirmatory diagnostic aid especially when it is needed. Results Seventy-two patients with cutaneous tuberculosis were seen and evaluated, their ages ranged from 6months-60 years with a median 28 years, with 42(58.33%) males and 30 (41.66%) females. The course of disease was chronic and the duration of rash ranged from 0.5-10 years. All parts of the body were affected, with limbs predominance 38(52.77%).The lower limbs were affected in 22 (30.55%) cases followed by upper limbs 16 (22.22%) cases , trunk 15 (20.83%), face 13(18%) and neck in 6 (8.33%) cases. In many patients, the initial lesions were inflammatory red cutaneous lumps and plaques that overtime change into different clinical lesions. The following clinical types were identified: cold abscesses and discharging sinuses were the most commonly diagnosed clinical variants as seen in 38 (52.77%) patients, followed by tuberculous chancre in 17 (23.61%), tuberculosis verrucosa cutis (warty TB) in 11 (15.27%) and orificial tuberculosis in 6 (8.23%) patients. No systemic involvement was documented in all patient apart from one patient with lung TB. No cases with classical lupus vulgaris were observed. The pathology of lesions were characteristically inflammatory lymphocytic granulomatous reactions.References
World Health Organization. Global tuberculosis report 2018:WHO/CDS/TB/2018.25. Geneva: WHO; 2018.
Sharquie K E, Noaimi A A, Khalaf F A. Granulomatous reaction at the site of positive tuberculin skin test is a marker of active TB (clinical and histopathological study). Am J Dermatol Venereol. 2019;8(4):55-60.
L. van Zyl, J. du Plessis, and J. Viljoen, Cutaneous tuberculosis overview and current treatment regimens. Tuberculosis. 2018;95:629-38.
Barbagallo J, Tager P, Ingleton R, et al.Cutaneous tuberculosis: diagnosis and treatment. Am J Clin Dermatol. 2002;3:319-28.
Santos JB, Figueiredo AR, Ferraz CE, et al. Tuberculose cutânea: aspectos epidemiológicos, etiopatogênicos e clínicos. An Bras Dermatol. 2014;89:219-28.
Silva M R , Castro M C R. Mycobacterial Infections. In: Bolognia JL, Sccaffer JV, Ceroni L. Text book of dermatology, 4th edition. China, Elsevir, 2018;12,75:1303-1309.
Frankel A, Penrose C, Emer J. Cutaneous tuberculosis: a practical case report and review for the dermatologist. J Clin Aesthet Dermatol. 2009;2:19-27.
Sehgal VN, Bhattacharya SN, Jain S, Logani K. Cutaneous tuberculosis: the evolving scenario. Int J Dermatol. 1994;33:97-104.
Brito AC, Oliveira CMM, Unger DA, Bittencourt MJS. Cutaneous tuberculosis: epidemiological, clinical, diagnostic and therapeutic update. Anais Brasileiros de Dermatologia.2022;97(2):129-144.
Warrell DA, Benz EJ, Cox TM, Firth JD, editors. Oxford Textbook of Medicine. Oxford University Press, USA;2003;557-62.
Tincopa Wong OW, Sánchez Saldana L. Tuberculosis cutánea. Dermatol Peru. 2003;13:195-214.
Chen Q, Chen W, Hao F .Cutaneous tuberculosis: A great imitator. Clin Dermatol. 2019;37:192-9.
Thakur BK, Verma S, Hazarika D. A clinicopathological study of cutaneous tuberculosis at Dibrugarh district, Assam. Indian J Dermatol. 2012;57:63-5.
Aruna C, Senthil Kumar AL, Sridevi K, et al. A clinicoepidemiological study of cutaneous tuberculosis in a tertiary care teaching hospital in Andhra Pradesh, India. Int J Res Dermatol. 2017;3:88-93.
Punia RS, Aggarwal P, Kundu R, et al. Aggarwal D. Cutaneous tuberculosis: A clinicopathological study of 50 cases from a tertiary care referral hospital. Appl Med Res. 2015;1:104-8.
Sehgal VN, Sardana K, Sharma S. Inadequacy of clinical and/or laboratory criteria for the diagnosis of lupus vulgaris, re-infection cutaneous tuberculosis: fallout/implication of 6 weeks of anti- tubular therapy (ATT) as a precise diagnostic supplement to complete the scheduled regimen. J Dermatol Treat. 2008;19:164-7.
Sehgal VN, Srivastava G, Khurana VK, et al. An appraisal of epidemiologic, clinical, bacteriologic, histopathologic and immunologic parameters in cutaneous tuberculosis. Int J Dermatol. 1987;26:521-6.
Gopinathan R, Pandit D, Joshi J, et al. Clinical and morphological variants of cutaneous tuberculosis and its relation to mycobacterium species. Indian J Med Microbiol. 2001;19:193-6.
Acharya KM, Ranpara H, Dutta R, Mehta B. A clinicopathological study of 50 cases of cutaneous tuberculosis in Jamnagar district. Indian J Dermatol Venereol Leprol. 1997;63:301-3.
Patra AC, Gharami RC, Banerjee PK. A profile of cutaneous tuberculosis. Indian J Dermatol. 2006;51:105-7.
Zinoune S, Baubay H, Assenhaji IL, et al. A cross study of cutaneous tuberculosis: A still relevant disease in Morocco (A study of 146 cases). Madridge J Case Rep Stud. 2019;3(1):126-9.
M. F. R. G. Dias, F. Bernardes Filho, M. V. Quaresma, et al. Update on cutaneous tuberculosis. Anais Brasileiros de Dermatologia.2014;89:925-38.
S. Ramarao, J. N. Greene, B. C. Casanas, et al. Cutaneous manifestation of tuberculosis. Infect Dis Clin Pract. 2012;20:376-83.
V. Ramesh. Sporotrichoid cutaneous tuberculosis. Clin Exp Dermatol. 2007;32:680-2.
Santos JB, Figueiredo AR, Ferraz CE, et al. Cutaneous tuber- culosis: Diagnosis, histopathology and treatment - Part II. Anais Brasileiros de Dermatologia. 2014;89:545-55.
Terranova M, Padovese V, Fornari U, Morrone A. Clinical and epidemiological study of cutaneous tuberculosis in Northern Ethiopia. Dermatology. 2008;217:89-93.
Chandran A, Antony C, Jose L, et al. Mycobacterium tuberculosis Infection Induces HDAC1-Mediated Suppression of IL-12B Gene Expression in Macrophages. Front Cell Infect Microbiol. 2015;5:90.
Sharquie K E, Jabbar R I. Major outbreak of dermatophyte infections leading into imitation of different skin diseases: trichophyton mentagrophytes is the main criminal fungus. J Turk Acad Dermatol. 2021;15(4):91-100.
Saher N, Wahid Z, Ahmed I, et al. Clinical presentations of cutaneous tuberculosis. J Pak Assoc Dermatol. 2014;24(2):132-7.
Padmavathy L, Lakshmana Rao L, Pari T, et al. Lupus vulgaris and tuberculosis verrucosa cutis-a clinical, pathological and epidemiological study of 71 cases. Indian J Tuberc. 2008;55:203-9.
Supekar BB, Wankhade VH, Singh RP, et al. Clinical Spectrum of Cutaneous Tuberculosis in Central India: A Retrospective Study. Indian Dermatol Online J. 2021;12(6):826-33.
Ramam M, Malhotra A, Tejasvi T, et al. How use-2.ful is the Mantoux test in the diagnosis of doubtful cases of cutaneous tuberculo-sis? Int J Dermatol. 2011;50:1379-82.
Sharquie K E , Noaimi A A, Al-Ghazzi A G. Treatment of cutaneous leishmaniasis by topical 25% podophyllin solution (single, blinded, therapeutic, controlled study). Journal of Dermatology & Dermatologic Surgery. 2015;19:108-113.
Sharquie KE, Jabbar RI. leishmania recidivans could be induced by intralesional infiltration of cutaneous leishmaniasis by sodium stibogluconate, with new therapeutic trial. J Clin Exp Invest. 2022;13(1):em00788.
Pacheco C, Silva E, Miranda J, Duarte R .Cutaneous tuberculosis as metastatic tuberculous abscess. J Bras Pneumol. 2015;41(2):200-2.
