Cutaneous tb is a relatively uncommon form of extrapulmonary tb tb infection of other organs and tissues. View the article pdf and any associated supplements and figures for a period of 48 hours. It is usually painless and occurs as a consequence of reexposure reinoculation to the mycobacterium in an individual with previous exposure. Based on the clinical features and histopathology a diagnosis of tuberculosis verrucosa cutis was made. Indolent, warty, plaquelike skin lesions arising by inoculation of tubercle bacilli in an individual previously infected with m. Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seedsthus the term miliary tuberculosis. What are synonyms for tuberculosis verrucosa cutis. Cutaneous chromoblastomycosis may clinically mimic cutaneous tuberculosis as both the condition usually presents with hyper pigmented verrucous lesion of skin. This case was misdiagnosed as tuberculosis verrucosa cutis clinically and undergone treatment for the same, with no response. Lupus vulgaris lv, tuberculosis verrucosa cutis tbvc, scrofuloderma scf, pulmonary. Diffuse keratoderma, tuberculosis verrucosa cutis, warty tuberculosis.
Tuberculosis tb is a global health problem with predominance in resourcepoor countries. We report a case of tuberculosis verrucosa cutis tbvc on the foot that had been present for more than 6 years in a 42yearold man. The term tuberculosis verrucosa cutis tvc was coined in 1869. Tuberculosis verrucosa cutis masqerading as chromoblastomycosis.
Case report tuberculosis verrucosa cutis in a patient with. Symmetrical scrofuloderma with tuberculosis verrucosa cutis. Tuberculosis verrucosa cutis presenting as diffuse plantar. Tuberculosis verrucosa cutis is a rash of small, red papular nodules in the skin that may appear 24 weeks after inoculation by mycobacterium tuberculosis in a previously infected and immunocompetent individual it is also known as prosectors wart, because it was a common occupational disease of prosectors, the preparers of dissections and autopsies. Tuberculosis verrucosa cutis is characterized by the presence of a solitary, verrucose plaque, usually on an extremity such as the hand or the foot. Clinically the condition may simulate tuberculosis verrucosa cutis, squamous cell carcinoma, plamoplantar psoriasis and sporotrichosis 1,2,3. Granulomatous syphilis, deep fungal infection, leishmaniasis pcr and culture studies may be needed for the distinction in difficult cases tuberculoid leprosy neural infiltration and less necrosis are clues to this diagnosis.
Kaposi was the first to define the mucocutaneous involvement seen in tb. A case of tuberculosis verrucosa cutisundiagnosed for 44 years and resulting in fixedflexion deformity of the arm. Pdf the epidemiological aspects and diagnostic problems encountered in a rural set up are largely unknown. Tuberculosis verrucosa cutis presenting as an annular hyperkeratotic plaque. Scrofuloderma associated with tuberculosis verrucosa cutis.
It is clinically classified as primary or secondary ot. Typical tuberculoid granulomas can be seen in the dermal inflammatory reaction of late primary inoculation tuberculosis, late miliary tuberculosis, tuberculosis cutis orificialis, tuberculosis verrucosa cutis prosectors wart, scrofuloderma, and lupus vulgaris. Cutaneous tb can either be of primary origin or secondary origin or it can be a part of a systemic infection. Tuberculosis verrucosa cutis synonyms, tuberculosis. Nontuberculous mycobacteria were grown in twenty patients. Of these, four two each from lupus vulgaris and verrucosa cutis were rapid growers and eight six from verrucosa cutis and two from lupus vulgaris were nonpigmented. Tuberculosis verrucosa cutis with multifocal involvement vora rv.
Secondary ot is the cutaneous tuberculosis type that occurs in patients with internal organ. Tb, consumption, consumption, phthisic, phthisis, white plague, t. Both the lesions were confirmed by histopathological examinations. In primary ot, the oral mucosa is the initial site of the infection without any internal organ involvement.
What is cutaneous tuberculosis cutaneous tuberculosis tb is essentially an invasion of the skin by mycobacterium tuberculosis, the same bacteria that cause tb of the lungs pulmonary tb. Tuberculosis verrucosa cutis developing over a keloid. Many unusual forms of cutaneous tuberculosis have been reported. Histopathology from skin lesion showing marked hyperkeratosis. Tuberculosis verrucosa cutis presenting as an annular.
Cutaneous chromoblastomycosis mimicking tuberculosis. A great imitator qiquan chen, md, phda, wenchieh chen, mdb. Extrapulmonary tb constitutes approximately 10% of the cases and can present as different forms depending on the route of entry. This case demonstrates the indolent nature of the disease. The latter appears to have a spectrum with lupus vulgaris high immunity at one end and tuberculosis cutis orificialis low immunity at the other, bridged by tbvc moderatehigh immunity and scrofuloderma low immunity. Rare case of multifocal cutaneous tuberculosis verrucosa. Tuberculosis verrucosa cutis abstract tuberculosis verrucosa cutis is a paucibacillary form of cutaneous tuberculosis caused by exogenous reinfection in previously sensitized individuals.
Characteristic morphology, positive mantoux test and histopathology corroborated in establishing the diagnosis of scrofuloderma with tuberculosis verrucosa cutis. Left groin showing three linear scars with sinus and crusted plaque and underlying swelling. Dermis tuberculosis cutis verrucosa information on the. Cutaneous tb can either be of primary origin or secondary origin or it can be a part of a systemic. Read cutaneous chromoblastomycosis mimicking tuberculosis verrucosa cutis. This diagnosis would show a vacuolar interface dermatitis with follicular plugging and periadnexal lymphocytic inflammation.
Tuberculosis verrucosa cutis bioline international. Tuberculosis verrucosa cutis on the sole of the foot. This disease is now rare in western countries and in india. Tuberculosis verrucosa cutis in a patient with keloid over. Tuberculosis verrucosa cutis tbvc or warty tuberculosis is a variant of cutaneous tuberculosis in patients with good cell mediated immunity cmi to mycobacterium tuberculosis, while miliary. Histopathology of the verrucous plaque revealed it to be tuberculosis verrucosa cutis tvc. Primary inoculation tuberculosis of the skin is the cutaneous analogue of the pulmonary ghon focus primary cutaneous tuberculosis may be associated with tattooing, ritual circumcision, nose piercing, inoculation of homeopathic solutions or injury by contaminated objects to laboratory workers, surgeons or prosectors. The precise diagnosis is often overlooked, due to clinical presentations as those of cutaneous diseases with different etiology and the relative paucity of the pathogens in the lesions. Pdf lupus vulgaris and tuberculosis verrucosa cutis tbvca. At the same time, tuberculous granulomas with caseous necrosis of moderate intensity are seen in the dermis and bacilli can be found. He had a positive mantoux test and a normal chest radiograph.
The wellformed epithelioid granulomas were observed in 84% of lupus vulgaris, all cases of scrofuloderma, and 89% cases of tuberculosis verrucosa cutis comparable to the studies conducted by sehgal et al 5 except for scrofuloderma where the author observed granuloma formation only. Sixty nine year old female presented to the skin outpatient department opd at a tertiary care center. Multifocal tuberculosis verrucosa cutis escholarship. Meanwhile, almost all of the diagnostic methods confer lower sensitivity and specificities which augments further diagnostic challenges. Cutaneous tuberculosis 355 cutaneous tuberculosis chapter 15 james w. Introduction history tuberculosis in antiquity observations during the 4th through 19th centuries the contributions of robert koch tuberculosis in the military epidemiology bacteriology histopathology classification primary. Tuberculosis verrucosa cutis tbvc, a verrucous form of cutaneous tuberculosis, occurs from inoculation of tubercle bacilli into the skin of a previously sensitized patient with moderate to high degree of immunity. Here we report a case of elderly female diagnosed with multifocal, multicentric tuberculosis verrucosa cutis. Tuberculosis verrucosa cutis definition of tuberculosis. Tuberculosis cutis verrucosa definition of tuberculosis.
Scrofuloderma was the most common form seen in 50% cases followed by lupus vulgaris in 42. Cutaneous tb is a small subset of the extrapulmonary tb. Tuberculosis verrucosa cutis tbvc virendra n sehgal. Tuberculosis verrucosa cutis article about tuberculosis.
Plasma cells are said to be more common in leprosy. Tubeculosis verrucosa cutis incidence tuberculosis verrucosa cutis is less common in western countries. Orificial tuberculosis ot constitutes 2% of cutaneous tuberculosis cases and 0. David weedon ao md frcpa fcaphon, in weedons skin pathology third edition, 2010. Tvc usually begins as a solitary papulonodule following a trivial injury or trauma on one of the extremities that soon acquires a. Warty tuberculosis tuberculous verrucosa cutis sensitized patient exogenous infection auto inoculation accidental inoculation. A yearold child had a rare presentation of bilateral symmetrical scrofuloderma from an underlying bony focus on both ankles, along with tuberculosis verrucosa cutis. Treatment 9 months initial phase 2 monthsinh,rif,pza,e continuation phase7 monthsinh, rif. We report this rare presentation of tvc as a cause of unilateral lymphedema. Even in countries such as india and china where tb still commonly occurs, cutaneous outbreaks. Tuberculosis verrucosa cutis is a form one of tuberculosis cutis that has a clinical feature of a typical form of solitary and multiple hyperkeratotic lesion, warts may also form plaques and often being suspect as warts.
Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions 15 mm. Tuberculosis verrucosa cutis tvc is a form of cutaneous tuberculosis that results from accidental inoculation of mycobacterium tuberculosis in a previously infected or sensitized individual with a moderate to high degree of slowly evolving cellmediated immunity. Lesions occur on those areas exposed to trauma and infected sputum or other tuberculous material. It is more common in the tropical regions and was the most common form of cutaneous tuberculosis reported in hong kong in 1968 46% of cases. Cutaneous tuberculosis continues to be one of the most elusive and more difficult diagnoses to make for dermatologists practicing in developing countries. Lupus vulgaris and tuberculosis verrucosa cutis tbvca clinical. Tuberculosis verrucosa cutis presenting with unilateral. Tuberculosis verrucosa cutis with multifocal involvement. Of various cutaneous forms, we report a case of tuberculosis verrucosa cutis in a 14 year old. Tuberculosis verrucosa cutis tvc is a common cutaneous form of paucibacillary tuberculosis in an individual with moderate to high degree of immunity to mycobacterium tuberculosis infection. Clinical appearance of tvc is mostly very typical with welldefined warty plaques presenting mostly on hands, knees, ankle, and buttocks. Differential diagnosis of cutaneous tuberculosis pathology. To the editor cutaneous tuberculosis may manifest either primary previously uninfectednon. The hands, knees, ankles and buttocks are most commonly.
Tuberculosis cutis orificialis in an immunocompetent. Synonyms for tuberculosis verrucosa cutis in free thesaurus. The causative agent is mycobacterium tuberculosis also known as the tubercle bacillus. Lupus vulgaris with tuberculosis verrucosa cutis prasad p, rao l l. Clinical and epidemiological observations of cutaneous tuberculosis in larkana, pakistan. The clinicopathological manifestations of cutaneous tuberculosis are diverse. Venereology skinvd centre, sehgal nursing home, panchwati, azadpur, delhi, departments of. Here in we report a case of chronic cutaneous chromoblastomycosis in a middle aged woman from north eastern part of india, who was initially misdiagnosed as tuberculosis verrucosa cutis. Tuberculosis verrucosa cutis tbvc is a paucibacillary form of cutaneous tuberculosis.
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