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Lalanda R, Barão A, Draiblate B, Malcato E, Matos H, Girão J, Rosa R, Freire JP, Miranda L. Perianal tuberculosis presenting as a Fournier's gangrene. Clin Case Rep 2024; 12:e8882. [PMID: 38707606 PMCID: PMC11066186 DOI: 10.1002/ccr3.8882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
Key Clinical Message In the setting of Fournier's gangrene, atypical clinical manifestations and complications in an immunocompetent patient warrant consideration of perineal tuberculosis as a potential underlying cause. Abstract Tuberculosis cutis orificialis is a rare form of extrapulmonary tuberculosis that affects the perianal region. Fournier's gangrene is an aggressive necrotizing fasciitis that primarily involves the perianal area and external genitalia. A previously healthy 38-year-old man presented with a left perianal abscess. His condition deteriorated, leading to septic shock and multiorgan dysfunction syndrome. A CT scan displayed extensive necrotizing fasciitis. Treatment included broad-spectrum antibiotics, numerous surgical perineal debridements, a transverse loop colostomy, and hyperbaric oxygen therapy. We believe the patient had pre-existing asymptomatic, non-diagnosed perianal tuberculosis, and a subsequent bacterial superinfection resulted in a perineal local abscess that progressed to severe Fournier's gangrene. The diagnosis of tuberculosis was confirmed through positive cultures and molecular identification in perineal biopsies. The patient experienced a complex clinical course with complications such as myocardial necrosis, acute respiratory distress syndrome, rhabdomyolysis with severe critical illness polyneuromyopathy and internal jugular thrombosis. Fournier's gangrene resulted in air dissection throughout the perineal fasciae, extending to the abdominal wall muscles resulting in an infected extraperitoneal spontaneous hematoma, probably caused by therapeutic anticoagulation. An extraperitoneal surgical drainage was performed. This case emphasizes the complexities in diagnosing and managing both perianal tuberculosis and Fournier's gangrene.
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Affiliation(s)
- Raquel Lalanda
- General Surgery Department—Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - Andreia Barão
- General Surgery Department—Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - Beatriz Draiblate
- General Surgery Department—Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - Ester Malcato
- General Surgery Department—Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - Hélder Matos
- General Surgery Department—Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - José Girão
- General Surgery Department—Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - Rosário Rosa
- General Surgery Department—Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - José Paulo Freire
- General Surgery Department—Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
| | - Luís Miranda
- General Surgery Department—Centro Hospitalar Universitário Lisboa Norte EPEHospital de Santa MariaLisbonPortugal
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Couppoussamy KI, Shanmugam S, Devanda R, Murugan R. Lupus vulgaris: a narrative review. Int J Dermatol 2024; 63:431-437. [PMID: 38102852 DOI: 10.1111/ijd.16987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/24/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
Lupus vulgaris (LV) is a type of paucibacillary cutaneous tuberculosis that can occur due to inoculation, lymphatic, or hematogenous route. It occurs in a previously sensitized individual with high immunity to tuberculosis. LV can have different morphology of presentation, which can lead to difficulty in diagnosis. The Tuberculin test is strongly positive. Histopathology will show epithelioid granulomas in the superficial dermis and acid-fast bacilli rarely demonstrable within the granulomas. Dermoscopy will show focused linear vessels on a yellow to orange background. Culture is the gold standard for diagnosis, but its positivity rate is low. Mycobacterium tuberculosis bacilli can be detected using polymerase chain reaction from the lesions. Histopathology, tuberculin test, dermoscopy, molecular test, and culture would help diagnose LV. This review discusses the introduction, pathogenesis, clinical features, differential diagnosis, investigations, complications, and treatment of lupus vulgaris in detail. This review can help the dermatologist understand the condition better with appropriate diagnosis and therapy.
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Affiliation(s)
- Kanmani Indra Couppoussamy
- Department of Dermatology and STD, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Srikanth Shanmugam
- Department of Dermatology and STD, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Rajendra Devanda
- Department of Dermatology and STD, National Institute of Medical Sciences and Research, Jaipur, India
| | - Roobashri Murugan
- Department of Pathology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
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3
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Tang Y, Zhu Y, You Z. Mycobacterium tuberculosis sepsis with multiple intermuscular abscesses and respiratory failure as the main manifestations: a case report. BMC Infect Dis 2024; 24:340. [PMID: 38515054 PMCID: PMC10956240 DOI: 10.1186/s12879-024-09187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Tuberculous sepsis is uncommon in individuals without human immunodeficiency virus (HIV) infection, and some patients may not exhibit clinical signs and symptoms of suspected sepsis upon admission, leading to delayed diagnosis and treatment. CASE PRESENTATION This report present the case of a 60-year-old female patient who presented with erythema, edema, and pain in her right upper limb accompanied by fever and chills. Further evaluation revealed multiple intermuscular abscesses caused by suspected gram-positive bacteria. Despite receiving anti-infection treatment, the patient rapidly progressed to septic shock and respiratory failure. Metagenomic next-generation sequencing (mNGS) analysis of blood samples detected Mycobacterium tuberculosis complex groups (11 reads). Additionally, mNGS analysis of fluid obtained from puncture of the abscess in the right upper extremity also suggested Mycobacterium tuberculosis complex groups (221 981 reads). Consequently, the patient was diagnosed with tuberculous sepsis resulting from hematogenous dissemination of Mycobacterium tuberculosis. Following the administration of anti-tuberculosis treatment, a gradual recovery was observed during the subsequent follow-up period. CONCLUSION It is noteworthy that atypical hematogenous disseminated tuberculosis can be prone to misdiagnosis or oversight, potentially leading to septic shock. This case illustrates the importance of early diagnosis and treatment of tuberculosis sepsis. Advanced diagnostic techniques such as mNGS can aid clinicians in the early identification of pathogens for definitive diagnosis.
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Affiliation(s)
- Yingzi Tang
- Department of Infectious Diseases, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Ying Zhu
- Department of Infectious Diseases, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Zhonglan You
- Department of Infectious Diseases, First Affiliated Hospital, Army Medical University, Chongqing, China.
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4
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Kharel M, Hossain MF. A case report of cutaneous tuberculosis. Int J Dermatol 2024; 63:213-216. [PMID: 38130036 DOI: 10.1111/ijd.16949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
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5
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Swaroop S, Srivastava P, Diwakar K, Biswal S. Calvarial Tuberculosis With Skin Tuberculosis in a Child: A Rare Case Report. Cureus 2024; 16:e52884. [PMID: 38406167 PMCID: PMC10894019 DOI: 10.7759/cureus.52884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Calvarial tuberculosis (TB) is an uncommon form of skeletal TB. Early diagnosis can be challenging as they may exhibit diagnostic dilemmas. Another rare kind of skin TB is called TB verrucosa cutis. In this case, both of these uncommon forms were observed simultaneously and were effectively treated with first-line antitubercular therapy.
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Affiliation(s)
- Shikha Swaroop
- Pediatrics, Tata Main Hospital, Manipal Tata Medical College, Manipal Institute of Higher Education (MAHE), Jamshedpur, IND
| | - Preeti Srivastava
- Pediatrics, Tata Main Hospital, Manipal Tata Medical College, Manipal Institute of Higher Education (MAHE), Jamshedpur, IND
| | - Kumar Diwakar
- Pediatrics, Tata Main Hospital, Manipal Tata Medical College, Manipal Institute of Higher Education (MAHE), Jamshedpur, IND
| | - Sumeet Biswal
- Pediatrics, Tata Main Hospital, Manipal Tata Medical College, Manipal Institute of Higher Education (MAHE), Jamshedpur, IND
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6
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Jacobson R, Gutierrez RA, Ghatnekar S, Virji AZ, Schwartz BS, Gensler LS, Haemel A, Frangos JE. Tuberculid reactions: A multi-institution cohort study from 2 academic medical centers in the United States. JAAD Int 2023; 13:68-70. [PMID: 37711341 PMCID: PMC10498287 DOI: 10.1016/j.jdin.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Affiliation(s)
- Rebecca Jacobson
- Department of Dermatology, University of California, San Francisco, California
| | | | - Shilpa Ghatnekar
- Department of Internal Medicine, Newton-Wellesley Hospital, Newton, Massachusetts
| | | | - Brian S. Schwartz
- Department of Medicine/Infectious Diseases, University of California, San Francisco, California
| | - Lianne S. Gensler
- Department of Medicine/Rheumatology, University of California, San Francisco, California
| | - Anna Haemel
- Department of Dermatology, University of California, San Francisco, California
| | - Jason E. Frangos
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
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7
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Kaul S, Kaur I, Mehta S, Singal A. Cutaneous tuberculosis. Part I: Pathogenesis, classification, and clinical features. J Am Acad Dermatol 2023; 89:1091-1103. [PMID: 35149149 DOI: 10.1016/j.jaad.2021.12.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 11/23/2022]
Abstract
Tuberculosis is an ancient disease that continues to affect an estimated 10 million people per year and is responsible for 1.4 million deaths per year. Additionally, the HIV epidemic and multidrug resistance present challenges to disease control. Cutaneous tuberculosis is an uncommon, often indolent, manifestation of mycobacterial infection that has a varied presentation. Its diagnosis is challenging, as lesions mimic other, more common conditions and microbiological confirmation is often not possible. Cutaneous tuberculosis can be broadly categorized into multibacillary and paucibacillary forms. Approximately one-third of skin tuberculosis is associated with systemic involvement. By recognizing cutaneous tuberculosis early, dermatologists can play an important role in disease control. The first article in this 2-part continuing medical education series describes the latest epidemiology, microbiology, and pathogenesis of tuberculosis. Furthermore, we review the classification, clinical manifestations, common clinical differentials, and systemic involvement that occur in cutaneous tuberculosis.
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Affiliation(s)
- Subuhi Kaul
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois
| | | | - Shilpa Mehta
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois.
| | - Archana Singal
- Department of Dermatology, University College of Medical Sciences & GTB Hospital, Delhi, India
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8
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Kaul S, Jakhar D, Mehta S, Singal A. Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment. J Am Acad Dermatol 2023; 89:1107-1119. [PMID: 35149148 DOI: 10.1016/j.jaad.2021.12.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
Despite the availability of effective treatment regimens for cutaneous tuberculosis, challenges to disease control result from delayed diagnosis, infection with multidrug-resistant mycobacterial strains, and coinfection with HIV. Delayed diagnosis can be mitigated when dermatologists are sensitized to the clinical signs and symptoms of infection and by the incorporation of appropriate diagnostic tests. All cases of cutaneous tuberculosis should be confirmed with histopathology and culture with or without molecular testing. In each case, a thorough evaluation for systemic involvement is necessary. Mycobacteria may not be isolated from cutaneous tuberculosis lesions and therefore, a trial of antituberculosis treatment may be required to confirm the diagnosis. The second article in this 2-part continuing medical education series describes the sequelae, histopathology, and treatment of tuberculosis.
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Affiliation(s)
- Subuhi Kaul
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois
| | | | - Shilpa Mehta
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois.
| | - Archana Singal
- Department of Dermatology, University College of Medical Sciences & GTB Hospital, Delhi, India
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9
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Brehm TT, Terhalle E. [Extrapulmonary tuberculosis]. Dtsch Med Wochenschr 2023; 148:1242-1249. [PMID: 37793616 DOI: 10.1055/a-1937-8186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Extrapulmonary tuberculosis (TB) presents unique diagnostic and therapeutic challenges. The site of involvement can vary widely, with common sites including the lymph nodes, pleura, skin, ear, nose and throat, genitourinary system, pericardium, gastrointestinal tract, bones and joints, and central nervous system. Clinical manifestations of extrapulmonary TB are diverse and often non-specific. Diagnosis is based on a combination of clinical suspicion, imaging, histopathology, and microbiology. Treatment of extrapulmonary TB generally follows similar principles to pulmonary TB, but the duration of treatment depends on the site of involvement and the extent of the disease. Increased awareness among healthcare providers is essential for the timely recognition and effective management of extrapulmonary TB cases.
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10
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Khabba CA, Asermouh M, Meziane M, Benzekri L, Senouci K. Reddish plaque and nodules on a child's cheek. JAAD Case Rep 2023; 39:37-39. [PMID: 37588800 PMCID: PMC10425777 DOI: 10.1016/j.jdcr.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Chaimae Ait Khabba
- Department of Dermatology-Venereology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Marwa Asermouh
- Department of Dermatology-Venereology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Mariame Meziane
- Department of Dermatology-Venereology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Laila. Benzekri
- Department of Dermatology-Venereology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Karima Senouci
- Department of Dermatology-Venereology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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11
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Zhu L, Dang Y, Yi M, Feng C, Geng S. A rare severe tuberculosis cutis orificialis in a patient with compound heterozygous mutations in the PRF1 gene. J Eur Acad Dermatol Venereol 2023; 37:e1109-e1111. [PMID: 37113032 DOI: 10.1111/jdv.19138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/24/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Longfei Zhu
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yang Dang
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Mengyao Yi
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Cheng Feng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Songmei Geng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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12
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Nguyen KH, Alcantara CA, Glassman I, May N, Mundra A, Mukundan A, Urness B, Yoon S, Sakaki R, Dayal S, Chowdhury T, Harshavardhan S, Ramanathan V, Venketaraman V. Cutaneous Manifestations of Mycobacterium tuberculosis: A Literature Review. Pathogens 2023; 12:920. [PMID: 37513768 PMCID: PMC10385667 DOI: 10.3390/pathogens12070920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Tuberculosis is an ancient disease that humanity struggled with for centuries and continues to struggle with. The bacteria Mycobacterium tuberculosis often infects the lungs through respiratory transmission and manifests itself through various symptoms, including cutaneous infections. Cutaneous tuberculosis (CTB) comprises about 1% to 1.5% of all extrapulmonary manifestations and is often accompanied by polymorphous lesions, including papules, nodules, plaques, ulcers, gummas, and verrucous lesions. CTB is most commonly observed in low-income, HIV, and immunosuppressed populations, similar to intrapulmonary manifestations. The main pathogen for CTB is M. tuberculosis but less commonly with M. bovis and BCG vaccine, and the modes of transmission are largely classified into exogenous and endogenous CTB. Current treatment options for CTB include oral therapy of antibiotic medications such as rifampicin, streptomycin, ethambutol, isoniazid, and pyrazinamide, which is occasionally combined with surgical intervention.
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Affiliation(s)
- Kevin H Nguyen
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Cheldon Ann Alcantara
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Ira Glassman
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Nicole May
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Akaash Mundra
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Abinanda Mukundan
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Bianca Urness
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Sonyeol Yoon
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Roajhaan Sakaki
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Surbi Dayal
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Tanzila Chowdhury
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Shakila Harshavardhan
- Department of Molecular Microbiology, Madurai Kamaraj University, Tamil Nadu 625021, India
| | - Vadakupattu Ramanathan
- Department of Pathology, National Institute for Research in Tuberculosis, Chennai 600031, India
| | - Vishwanath Venketaraman
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
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13
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Bánvölgyi A, Avci P, Kiss N, Meznerics FA, Jobbágy A, Fésűs L, Hársing J, Kuroli E, Szepesi Á, Marschalkó M. Scrofuloderma and granuloma annulare-like lesions: Challenges of diagnosing cutaneous tuberculosis in developed countries. J Clin Tuberc Other Mycobact Dis 2023; 31:100370. [PMID: 37122612 PMCID: PMC10130622 DOI: 10.1016/j.jctube.2023.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Tuberculosis remains a global health concern, as the increasing levels of urban poverty, higher number of immunodeficient patients and the development of drug resistance threaten the overall efforts made to induce a downward trend for the disease. Scrofuloderma, also known as tuberculosis cutis colliquativa is a subtype of cutaneous tuberculosis. Here we detail a case of a 70-year-old female patient presented with unilateral, left-sided, multiple palpable, painful, ulcerated and purulent cervical nodules, accompanied by persistent generalized erythematous popular granuloma annulare-like skin lesions on the upper extremities. Based on the result of the PCR assay, culture, imaging and histopathological findings, the diagnosis of scrofuloderma was established. To achieve prompt diagnosis and early treatment, it is crucial to include scrofuloderma in the differential diagnosis of ulcerated lesions in developed countries as well, and also be aware of the additional clinical symptoms, such as granuloma annulare-like lesions, possibly accompanying cutaneous tuberculosis.
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Affiliation(s)
- András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
- Corresponding author at: Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, 41 Mária utca, Budapest H-1085, Hungary.
| | - Pinar Avci
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Fanni Adél Meznerics
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Antal Jobbágy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Luca Fésűs
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Judit Hársing
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Ágota Szepesi
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Márta Marschalkó
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
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14
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Agudelo Rojas OL, Torres Soto SA, Ruiz Suarez AC, Mejía Giraldo AM, Garcia SC. Cutaneous tuberculosis as a manifestation of Pott's Disease: A diagnostic challenge in patients with Non-HIV immunosuppression. Int J Mycobacteriol 2023; 12:192-195. [PMID: 37338483 DOI: 10.4103/ijmy.ijmy_220_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Tuberculosis (TB) is one of the most important public health issues in developing countries. The World Health Organization estimates that approximately 20%-40% of the world's population is infected. Pulmonary forms account for the majority of cases; however, it can manifest as extrapulmonary disease in 8.4%-13.7% of cases. Of these extrapulmonary forms of TB, only 1%-2% may have skin manifestations. Cutaneous tuberculosis (CTB) is relatively uncommon and is not a well-defined disease, which complicates diagnosis. We present two patients with Pott's disease that manifested as CTB, one with tuberculous gumma and the other with scrofuloderma. Both patients with non-HIV immunosuppression. The diagnosis of CTB was made by detecting Mycobacterium tuberculosis in skin samples by real-time polymerase chain reaction (Xpert MTB/RIF test) and Ziehl-Neelsen staining. The histologic findings described in these two forms of TB may vary or be absent in immunosuppressed patients, making diagnosis difficult.
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Affiliation(s)
- Olga Lucia Agudelo Rojas
- Facultad Ciencias de la Salud, Universidad CES; Servicio Patología, Clínica CES, Medellín, Colombia
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15
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Fontana MC, Bosch P, Yarza M, Rueda ML, Laffargue J, Cao G, Denielian S, Grees SA. [Translated article] Disseminated Bacillus Calmette-Guérin Infection in a Young Girl Leading to a Diagnosis of Immunodeficiency. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113 Suppl 1:TS2-TS4. [PMID: 36240877 DOI: 10.1016/j.ad.2022.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/15/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- M C Fontana
- Medica Pediátra, 3er año de la Carrera de Especialista en Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina.
| | - P Bosch
- Instructora de Residentes en Dermatología Infantil, Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - M Yarza
- Medico de Planta Permanente Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - M L Rueda
- Medico de Planta Permanente Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - J Laffargue
- Medico de Planta Permanente Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - G Cao
- Jefe del Servicio de Anatomía Patológica, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - S Denielian
- Jefa del Laboratorio de Biología Molecular Inmunología, Hospital de Pediatría SAMIC "Prof. Dr. Juan Pedro Garrahan" CABA, Buenos Aires, Argentina
| | - S A Grees
- Jefa del Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
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16
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Fontana MC, Bosch P, Yarza M, Rueda ML, Laffargue JA, Cao G, Danielian S, Grees SA. Disseminated Bacillus Calmette-Guérin Infection in a Young Girl Leading to a Diagnosis of Immunodeficiency. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113 Suppl 1:S2-S4. [PMID: 36543462 DOI: 10.1016/j.ad.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- M C Fontana
- Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina.
| | - P Bosch
- Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - M Yarza
- Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - M L Rueda
- Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - J A Laffargue
- Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - G Cao
- Servicio de Anatomía Patológica, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
| | - S Danielian
- Laboratorio de Biología Molecular Inmunología, Hospital de Pediatría SAMIC «Prof. Dr. Juan Pedro Garrahan» CABA, Buenos Aires, Argentina
| | - S A Grees
- Servicio de Dermatología Infantil, Hospital General de Niños Dr. Pedro de Elizalde, CABA, Buenos Aires, Argentina
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17
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Duan X, Xiong X, Yu H, Deng L. Unilateral Lower Extremity Elephantiasis. Clin Infect Dis 2022; 75:2035-2037. [PMID: 36449404 DOI: 10.1093/cid/ciac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Xi Duan
- Department of Dermatology, First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China.,Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xincai Xiong
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hai Yu
- Department of Dermatology, First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
| | - Liehua Deng
- Department of Dermatology, First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
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18
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Garon L, Hill A. A case of scrofuloderma of the axilla presenting as hidradenitis suppurativa: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221117706. [PMID: 36225223 PMCID: PMC9549081 DOI: 10.1177/2050313x221117706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Scrofuloderma is an uncommon cutaneous presentation of tuberculosis. It can be
difficult to diagnose, as it can mimic various skin conditions, including
hidradenitis suppurativa. We report a case of a 46-year-old female refugee
patient with a history of nodules and sinus tracts in the left axilla treated
for many years as hidradenitis suppurativa in her home country who was later
found to have scrofuloderma. The diagnosis was based on a positive
Mycobacterium tuberculosis polymerase chain reaction from
an ultrasound-guided aspiration. Further investigation excluded pulmonary
tuberculosis. In cases with an atypical presentation of hidradenitis
suppurativa, imaging, along with histological and microbiologic examination are
warranted to exclude scrofuloderma.
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Affiliation(s)
- Laurence Garon
- Laurence Garon, Division of Dermatology,
Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM),
Montréal, QC, Canada H2X 0C1.
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19
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Abstract
Annular configuration is conspicuous in the clinical manifestation of many skin diseases and can be helpful for the diagnosis and differential diagnosis. Variations may include arciform, ring-form, annular, circinate, serpiginous, gyrated, polycyclic, targeted or figurate forms, in different colors, sizes, and numbers, with various textures and surfaces. In infectious dermatoses, the annular reactions can be specific or nonspecific, while the underlying mechanisms remain largely unknown. In the specific reactions caused by direct invasion of the pathogens, the contest between the centrifugal outspread of the infectious agents and the centripetal impedance of the host immune response is supposed to determine the final conformation. Examples include erythema infectiosum, orf, erythema multiforme, and pityriasis rosea of viral origin. Bacterial infections that may display annular lesions include erythrasma, erythema (chronicum) migrans of Lyme borreliosis, secondary syphilis, cutaneous tuberculosis, and leprosy. Superficial mycosis, such as dermatophytosis, candida intertrigo, tinea imbricata, and subcutaneous mycosis, such as chromoblastomycosis, and algae infection protothecosis, are characterized by annular progression of the skin lesions. The creeping serpiginous extension is an alarming sign for the diagnosis of cutaneous larva migrans. A better understanding of the virulence and pathogenicity of the pathogens and the way and type of immune response will help to clarify the pathogenesis.
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Affiliation(s)
- Wei-Ting Liu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Lun Sun
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kusmarinah Bramono
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Mohammad Ezmerli
- Department of Dermatology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Chao-Chun Yang
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan.
| | - WenChieh Chen
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
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20
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Xue T, Lu Z, Zhang W, Wang Z, Shi Y, Jiang H, Wang H. Facial Erythema Due to Lupus Vulgaris and Candida albicans Infections: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:1397-1402. [PMID: 35910508 PMCID: PMC9325874 DOI: 10.2147/ccid.s372359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022]
Abstract
Co-infection of Mycobacterium tuberculosis (MTB) and Candida albicans with erythema on the face is rare. A familiar red spot on the face can easily lead to missed diagnosis and misdiagnosis. Untreated lupus vulgaris (LV) can form scar tissue. And the fungal infection that cannot be diagnosed and treated timely can also lead to failure of LV treatment, resulting in facial scarring, disfigurement, and psychological stress. In this study, we reported a case of a 58-year-old immunocompetent female co-infected with MTB and Candida albicans on her face. After anti-tuberculous and anti-fungal therapy, she recovered with no scar on her face.
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Affiliation(s)
- Tianping Xue
- Department of Dermatology, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Zhenzhong Lu
- Department of Dermatology, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Wenyue Zhang
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China
| | - Zhenzhen Wang
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China
| | - Ying Shi
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China
| | - Haiqin Jiang
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China
| | - Hongsheng Wang
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.,Centre for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
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21
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Rustad AM, Hughes ZH, Osborn RL, Bhasin A. Non-pulmonary Disseminated Tuberculosis Complicated by Constrictive Pericarditis and Cutaneous Gumma. J Gen Intern Med 2022; 37:2568-2572. [PMID: 35501629 PMCID: PMC9060403 DOI: 10.1007/s11606-022-07619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/12/2022] [Indexed: 12/02/2022]
Abstract
A 23-year-old previously healthy male presented to the hospital with symptoms of heart failure. He was diagnosed with pericarditis and found to have a reduced left ventricular ejection fraction of 25%. He was noted to have mediastinal lymphadenopathy. Pulmonary and abdominal sampling were non-diagnostic for infection, autoimmune disease, or malignancy. A QuantiFERON Gold returned positive. After a thorough travel history and detailed exam, the patient was diagnosed with disseminated tuberculosis after the discovery of a cutaneous gumma that was found to have acid-fast bacilli present on biopsy with Fite's stain. 18F-FDG PET CT and cardiac MRI were pursued given that pericardial and myocardial biopsy could not be safely performed due to the patient's hemodynamics. 18F-FDG PET CT and cardiac MRI did not demonstrate any myocardial pathology responsible for the left ventricular ejection fraction. This case highlights that pulmonary involvement is not necessary for disseminated TB, Fite's stain may be used to identify M. tuberculosis, and that cardiac MRI and 18F-FDG PET CT may be useful to delineate myocardial involvement in high-risk situations.
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Affiliation(s)
- Andrea M Rustad
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zachary H Hughes
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rebecca L Osborn
- Division of Infectious Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ajay Bhasin
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Division of Hospital-Based Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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22
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Haddad GR, Florêncio LC, Haddad Junior V. Cutaneous tuberculosis chancre: case description in a child. An Bras Dermatol 2022; 97:685-687. [PMID: 35853774 PMCID: PMC9453483 DOI: 10.1016/j.abd.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gabriela Roncada Haddad
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Lívia Caramaschi Florêncio
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Vidal Haddad Junior
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
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23
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Abstract
BACKGROUND Hand infections caused by mycobacteria are relatively uncommon compared to infections caused by other pathogens; therefore, much of the available literature consists of case reports and limited case series. Broadly categorized into tuberculous and nontuberculous mycobacterial (NTM) infections, both tuberculous and NTM infections are typically insidious with long incubation periods and with the ability to remain dormant for prolonged periods. METHODS We reviewed the most current literature on the epidemiology, presentations, treatment methods, and resistance patterns of mycobacterial infections of the hand focusing on the indications and outcomes of nonoperative as well as operative interventions. RESULTS The worldwide burden of tuberculosis remains high and while the overall rate of new diagnosis drug resistant tuberculosis has been on the decline some regions of the world have demonstrated staggeringly high resistance rates to first-line tuberculosis therapies. Signs and symptoms of mycobacterial hand infection are typically inconsistent, and highly dependent on the specific structures of the hand that are affected; therefore, these infections may mimic other infections of the hand like tenosynovitis, joint space infections, and cutaneous infections. The main stay of treatment remains antimycobacterial therapies including but not limited to rifampin, isoniazid, pyrazinamide, and ethambutol. CONCLUSIONS The complications associated with mycobacterial hand infections can be significant. Prompt evaluation, including a thorough history to evaluate for potential exposures to infectious sources, followed by appropriate antibiotic choice and duration, with surgical management as needed, is key to reducing the chance that patients experience lasting effects of the infection.
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Affiliation(s)
- Vivek K. Bilolikar
- Thomas Jefferson University, Philadelphia PA, USA,Vivek K. Bilolikar, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street #100, Philadelphia, PA 19107, USA.
| | - Asif M. Ilyas
- Thomas Jefferson University, Philadelphia PA, USA,Rothman Orthopaedic Institute, Philadelphia, PA, USA
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24
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van Staden D, Haynes RK, Viljoen JM. Adapting Clofazimine for Treatment of Cutaneous Tuberculosis by Using Self-Double-Emulsifying Drug Delivery Systems. Antibiotics (Basel) 2022; 11:antibiotics11060806. [PMID: 35740212 PMCID: PMC9219976 DOI: 10.3390/antibiotics11060806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 12/10/2022] Open
Abstract
Although chemotherapeutic treatment regimens are currently available, and considerable effort has been lavished on the development of new drugs for the treatment of tuberculosis (TB), the disease remains deeply intractable and widespread. This is due not only to the nature of the life cycle and extraordinarily disseminated habitat of the causative pathogen, principally Mycobacterium tuberculosis (Mtb), in humans and the multi-drug resistance of Mtb to current drugs, but especially also to the difficulty of enabling universal treatment of individuals, immunocompromised or otherwise, in widely differing socio-economic environments. For the purpose of globally eliminating TB by 2035, the World Health Organization (WHO) introduced the "End-TB" initiative by employing interventions focusing on high impact, integrated and patient-centered approaches, such as individualized therapy. However, the extraordinary shortfall in stipulated aims, for example in actual treatment and in TB preventative treatments during the period 2018-2022, latterly and greatly exacerbated by the COVID-19 pandemic, means that even greater pressure is now placed on enhancing our scientific understanding of the disease, repurposing or repositioning old drugs and developing new drugs as well as evolving innovative treatment methods. In the specific context of multidrug resistant Mtb, it is furthermore noted that the incidence of extra-pulmonary TB (EPTB) has significantly increased. This review focusses on the potential of utilizing self-double-emulsifying drug delivery systems (SDEDDSs) as topical drug delivery systems for the dermal route of administration to aid in treatment of cutaneous TB (CTB) and other mycobacterial infections as a prelude to evaluating related systems for more effective treatment of CTB and other mycobacterial infections at large. As a starting point, we consider here the possibility of adapting the highly lipophilic riminophenazine clofazimine, with its potential for treatment of multi-drug resistant TB, for this purpose. Additionally, recently reported synergism achieved by adding clofazimine to first-line TB regimens signifies the need to consider clofazimine. Thus, the biological effects and pharmacology of clofazimine are reviewed. The potential of plant-based oils acting as emulsifiers, skin penetration enhancers as well as these materials behaving as anti-microbial components for transporting the incorporated drug are also discussed.
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25
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Singal A, Kaur I, Jakhar D, Pandhi D, Grover C, Gandhi V. Clinicoepidemiological characteristics of cutaneous tuberculosis in 1458 Indian patients: a retrospective analytical study from a tertiary care center. Int J Dermatol 2022; 61:1012-1022. [PMID: 35583803 DOI: 10.1111/ijd.16267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/27/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Tuberculosis (TB) has been one of the most challenging infectious diseases globally. Cutaneous tuberculosis (CTB) accounts for 0.5-2% of extrapulmonary TB and is often missed owing to its varying morphology and paucibacillary nature. METHODS In this retrospective analytical study, we share our 22-year experience to describe the clinicoepidemiological features and treatment response of CTB in 1458 Indian patients. In each patient, detailed history was followed by clinical examination, hematological and biochemical investigations, Mantoux testing, chest x-ray, and other specialized investigations to detect coexisting systemic foci. Clinical diagnosis of CTB was confirmed on histopathology/cytology and response to standard antitubercular treatment (ATT). All details were recorded on a predesigned proforma. RESULTS Of 1458 eligible patients, 803 were children. The mean disease duration was 15.3 months. Lupus vulgaris (40.4%) was the most common clinical variant, followed by scrofuloderma (32.7%) and lichen scrofulosorum (15.2%). Other variants included tuberculosis verrucosa cutis, gumma, tuberculids, and inoculation TB. Multiple clinical variants were observed in 3.6% of patients. A total of 41.4% of patients had coexistent systemic foci; in lymph nodes (50.4%), lungs (35.6%), bone (10.3%), and abdomen (5.8%). TB foci were also observed at uncommon locations like the eye, central nervous system, and genital organs. Treatment response to ATT was favorable in 99.2%. INTERPRETATION The burden of CTB still persists in developing countries. The diagnosis is often missed due to the wide spectrum of clinical and histological presentations. Awareness among clinicians of varying aspects of CTB is of paramount importance for early diagnosis and management and will significantly prevent morbidity and disease complications.
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Affiliation(s)
- Archana Singal
- Department of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
| | | | | | - Deepika Pandhi
- Department of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
| | - Chander Grover
- Department of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
| | - Vijay Gandhi
- Department of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
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26
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Tomov G, Voynov P, Bachurska S. Granulomatous Cheilitis or Tuberculid? Antibiotics (Basel) 2022; 11:antibiotics11040522. [PMID: 35453273 PMCID: PMC9031045 DOI: 10.3390/antibiotics11040522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
The granulomatous cheilitis (GC) presents a heterogeneous group of disorders characterised by a granulomatous inflammation/reaction of the lips to various stimuli. Numerous etiologies have been proposed, including genetic, immunologic, allergic and infectious. Among the secondary causes of GC, an infection by Mycobacterium tuberculosis (MBT) should be considered. In such cases, the GC could be the clinical presentation of a tuberculid resulting from a hypersensitivity reaction to an underlying focus of active (ATBI) or latent tuberculosis infection (LTBI). This communication describes an immunocompetent patient diagnosed with GC resulting from tuberculid, who responded well to Isoniazid monotherapy.
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Affiliation(s)
- Georgi Tomov
- Department of Periodontology and Oral Mucosa Diseases, Faculty of Dental Medicine, Medical University of Plovdiv, 15-A “Vasil Aprilov” Blvd, 4002 Plovdiv, Bulgaria
- Correspondence: ; Tel.: +359-896-742-065
| | - Parvan Voynov
- Plastic and Reconstructive Surgery Division, UNI Hospital, 100 Georgi Benkovski Str., 4500 Panagyurishte, Bulgaria;
| | - Svitlana Bachurska
- Department of Pathology, National Oncology Hospital, 6 Plovdivsko Pole Str., 1756 Sofia, Bulgaria;
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27
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Villagrasa-Boli P, Monte-Serrano J, Alcon-Flores F. Masa cervical supurativa en paciente con lesiones pulmonares. Semergen 2022; 48:e23-e24. [PMID: 35151556 DOI: 10.1016/j.semerg.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
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28
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Baykan AH, Sayiner HS, Aydin E, Koc M, Inan I, Erturk SM. Extrapulmonary tuberculosıs: an old but resurgent problem. Insights Imaging 2022; 13:39. [PMID: 35254534 PMCID: PMC8901940 DOI: 10.1186/s13244-022-01172-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/03/2022] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis (TB) primarily affects the lungs, but some of its most devastating clinical consequences arise because of its ability to spread from the lungs to other organs. Extrapulmonary TB (EPTB) constitutes 15–20% of all TB cases. Imaging findings are not always specific and can mimic many diseases; therefore, EPTB should be considered in the differential diagnosis, particularly in patients with immune system disorders (AIDS, patients receiving chemotherapy, etc.) and those in other high-risk groups including people with diabetes. The bacterium's passage to the regional lymph nodes is essential for developing a protective T-cell-mediated immune response, but the bacterium can spread hematologically and via the lymphatic system, leading to extrapulmonary involvement. Diagnosis of EPTB in high-risk patients is made based on suspected clinical and radiological findings, but further positive culture and histopathological confirmation may be required in some instances. Radiological evaluations are critical for diagnosis and crucial in planning the treatment and follow-up. This paper aims to review the typical and atypical imaging features and the differential diagnosis of EPTB.
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29
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Brito ACD, Oliveira CMMD, Unger DAA, Bittencourt MDJS. Cutaneous tuberculosis: epidemiological, clinical, diagnostic and therapeutic update. An Bras Dermatol 2022; 97:129-144. [PMID: 34996655 PMCID: PMC9073256 DOI: 10.1016/j.abd.2021.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis is certainly one of the diseases considered to be ancient on planet Earth. The etiological agent of tuberculosis is Mycobacterium tuberculosis. This terrible bacterial infection still results in severe socioeconomic consequences to date, and its complete eradication represents a great challenge. It constitutes one of the most important public health problems in developing countries. According to the World Health Organization, this infection results in more than 4,000 deaths daily worldwide, with 10.4 million being affected annually and 1.5 million deaths from TB every year. With the emergence of the HIV/AIDS pandemic, the disease became the main cause of morbidity and mortality in patients infected with the human immunodeficiency virus. Cutaneous tuberculosis is a rare infection that represents 1% to 1.5% of extrapulmonary tuberculosis, whose etiological agents are Mycobacterium tuberculosis, Mycobacterium bovis, and the attenuated form of the bacillus Calmette-Guérin (BCG vaccine). Cutaneous tuberculosis can be exogenous; endogenous: caused by contiguity or autoinoculation and by hematogenous spread; induced by the Calmette-Guérin bacillus and manifest as a tuberculid. The diagnosis of the infection is carried out through the direct test, culture, histopathology, tuberculin skin test, polymerase chain reaction, interferon-gamma release assay, and genotyping. Drugs used comprise isoniazid, rifampicin, pyrazinamide and ethambutol.
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30
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Malik MNH, Waqas SFH, Zeitvogel J, Cheng J, Geffers R, Gouda ZAE, Elsaman AM, Radwan AR, Schefzyk M, Braubach P, Auber B, Olmer R, Müsken M, Roesner LM, Gerold G, Schuchardt S, Merkert S, Martin U, Meissner F, Werfel T, Pessler F. Congenital deficiency reveals critical role of ISG15 in skin homeostasis. J Clin Invest 2021; 132:141573. [PMID: 34847081 PMCID: PMC8803340 DOI: 10.1172/jci141573] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
Ulcerating skin lesions are manifestations of human ISG15 deficiency, a type I interferonopathy. However, chronic inflammation may not be their exclusive cause. We describe two siblings with recurrent skin ulcers that healed with scar formation upon corticosteroid treatment. Both had a homozygous nonsense mutation in the ISG15 gene, leading to unstable ISG15 protein lacking the functional domain. We characterized ISG15–/– dermal fibroblasts, HaCaT keratinocytes, and human induced pluripotent stem cell–derived vascular endothelial cells. ISG15-deficient cells exhibited the expected hyperinflammatory phenotype, but also dysregulated expression of molecules critical for connective tissue and epidermis integrity, including reduced collagens and adhesion molecules, but increased matrix metalloproteinases. ISG15–/– fibroblasts exhibited elevated ROS levels and reduced ROS scavenger expression. As opposed to hyperinflammation, defective collagen and integrin synthesis was not rescued by conjugation-deficient ISG15. Cell migration was retarded in ISG15–/– fibroblasts and HaCaT keratinocytes, but normalized under ruxolitinib treatment. Desmosome density was reduced in an ISG15–/– 3D epidermis model. Additionally, there were loose architecture and reduced collagen and desmoglein expression, which could be reversed by treatment with ruxolitinib/doxycycline/TGF-β1. These results reveal critical roles of ISG15 in maintaining cell migration and epidermis and connective tissue homeostasis, whereby the latter likely requires its conjugation to yet unidentified targets.
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Affiliation(s)
- Muhammad Nasir Hayat Malik
- Biomarkers for Infectious Diseases, Centre for Experimental and Clinical Infection Research, Twincore, Hannover, Germany
| | - Syed F Hassnain Waqas
- Biomarkers for Infectious Diseases, Centre for Experimental and Clinical Infection Research, Twincore, Hannover, Germany
| | - Jana Zeitvogel
- Institute for Dermatology, Allergology and Venerology, Hannover Medical School (MHH), Hannover, Germany
| | - Jingyuan Cheng
- Experimental Systems Immunology, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Robert Geffers
- Genome Analytics, Helmholtz Center for Infection Research, Braunschweig, Germany
| | | | | | - Ahmed R Radwan
- Department of Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | - Matthias Schefzyk
- Institute for Dermatology, Allergology and Venerology, Hannover Medical School (MHH), Hannover, Germany
| | - Peter Braubach
- Institute for Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Bernd Auber
- Institute for Human Genetics, Hannover Medical School (MHH), Hannover, Germany
| | - Ruth Olmer
- LEBAO, Hannover Medical School (MHH), Hannover, Germany
| | - Mathias Müsken
- Central Facility for Microscopy, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Lennart M Roesner
- Genome Analytics, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Gisa Gerold
- Institute for Experimental Virology, TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Sven Schuchardt
- Department of Bio and Environmental Analytics, Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | | | - Ulrich Martin
- LEBAO, Hannover Medical School (MHH), Hannover, Germany
| | - Felix Meissner
- Experimental Systems Immunology, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Thomas Werfel
- Genome Analytics, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Frank Pessler
- Biomarkers for Infectious Diseases, Centre for Experimental and Clinical Infection Research, Twincore, Hannover, Germany
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Sabbadini C, Oberschmied J, Tauber M, Nobile C. A rare case of scrofuloderma along with lupus vulgaris. Dermatol Reports 2021; 13:8993. [PMID: 34880968 PMCID: PMC8611515 DOI: 10.4081/dr.2021.8993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Cutaneous forms of tuberculosis are rare, comprising about 1-1.5% of all cases, and show a wide range of clinical manifestations. Here we present a case of a patient with left cervical ulcerated lymphadenopathy associated with a violaceous plaque in the area of the manubrium of sternum. We performed a biopsy of the plaque for histopathology, a polymerase chain reaction (PCR) to test for mycobacteria and a smear of the ulcerated lymph node. Histopathology results showed a dermal infiltrate consisting of epithelioid granulomas without necrosis, PCR was negative, and the culture was positive for M. tuberculosis. We made the diagnosis of scrofuloderma associated with lupus vulgaris. The patient was treated with an anti-tuberculous therapy with clinical regression of the lesions. Our case emphasizes the importance of recognizing that tuberculosis can occur as a primary cutaneous pathology, with a challenging diagnosis that requires the correlation of clinical findings with diagnostic testing. Transient acantholytic dermatosis (TAD) is a relatively common entity that has been also noted to occur in patients with cancer. Herein, we describe a case of transient acantholytic dermatosis occurring in a patient with a history of prostate cancer status post radiation, now being treated with combination therapy with pembrolizumab and carboplatin-pemetrexed for advanced lung adenocarcinoma. Our case emphasizes the importance of being cognizant of TAD and its associations, particularly in cancer patients.
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Affiliation(s)
- Chiara Sabbadini
- Department of Dermatology, Venereology and Allergology, Hospital Brunico, Brunico
| | - Julia Oberschmied
- Department of Dermatology, Venereology and Allergology, Hospital Brunico, Brunico
| | - Martina Tauber
- Department of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Carla Nobile
- Department of Dermatology, Venereology and Allergology, Hospital Brunico, Brunico
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The master of masquerade: A case series of unusual presentations of cutaneous tuberculosis in the immunocompromised host. Indian J Tuberc 2021; 68:540-543. [PMID: 34752327 DOI: 10.1016/j.ijtb.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022]
Abstract
Cutaneous tuberculosis is known for its varied presentations, especially in the setting of immunosuppression. Clinical manifestations can be modified by the site of involvement as well as the type of cutaneous tuberculosis in a particular patient. Although cutaneous tuberculosis only accounts for a small percentage (1-2%) of extrapulmonary cases, it is encountered fairly frequently in dermatology practice in an endemic country like India. These cases are being presented to highlight unusual presentations of well-known forms of cutaneous TB (TB gumma and erythema induratum of Bazin) and rare morphologies (panniculitis) in immunosuppressed individuals, thereby emphasizing the need for the dermatologist in a TB-endemic country to be constantly vigilant.
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33
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Alam MA, Ahmed MN, Khan AH, Arafat SM. Metastatic tuberculous abscess: A rare manifestation of cutaneous tuberculosis. IDCases 2021; 26:e01257. [PMID: 34485079 PMCID: PMC8399307 DOI: 10.1016/j.idcr.2021.e01257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 11/27/2022] Open
Abstract
Cutaneous tuberculosis (CTB), a rare manifestation of tuberculosis is one of the most challenging diagnoses to establish. Metastasic tuberculous abscess is a form of CTB which is characterized by cold abscesses on the patient's extremities or trunk without any involvement of underlying tissue. Here we report a case of 56-year-old Bangladeshi male with no previous history of TB, who presented with multiple abscesses over the body for 3 months. His diagnosis was confirmed on the basis of demonstration of Mycobacterium tuberculosis in the lesions by staining, PCR and culture. But no primary focus was found. After 1 month of anti-tubercular therapy, significant improvement was noted.
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Affiliation(s)
- M A Alam
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Abed Hussain Khan
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shohael Mahmud Arafat
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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34
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena M, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín J, Ríos-Viñuela E, Rodríguez Peralto J, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda J, Velasco Benito V, Beato Merino M, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses — Part 2. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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35
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Razack R, Claasens S, Schubert PT, van Zyl A. Myth or mycobacterium? Negative image cytology revisited in a case of an atypical mycobacterial cutaneous infection. Diagn Cytopathol 2021; 49:1059-1062. [PMID: 34191403 DOI: 10.1002/dc.24820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Rubina Razack
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Saskya Claasens
- Department of Dermatology, Tygerberg Hospital, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Pawel T Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Adri van Zyl
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
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36
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Cooper EE, Pisano CE, Shapiro SC. Cutaneous Manifestations of "Lupus": Systemic Lupus Erythematosus and Beyond. Int J Rheumatol 2021; 2021:6610509. [PMID: 34113383 PMCID: PMC8154312 DOI: 10.1155/2021/6610509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022] Open
Abstract
Lupus, Latin for "wolf," is a term used to describe many dermatologic conditions, some of which are related to underlying systemic lupus erythematosus, while others are distinct disease processes. Cutaneous lupus erythematosus includes a wide array of visible skin manifestations and can progress to systemic lupus erythematosus in some cases. Cutaneous lupus can be subdivided into three main categories: acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus. Physical exam, laboratory studies, and histopathology enable differentiation of cutaneous lupus subtypes. This differentiation is paramount as the subtype of cutaneous lupus informs upon treatment, disease monitoring, and prognostication. This review outlines the different cutaneous manifestations of lupus erythematosus and provides an update on both topical and systemic treatment options for these patients. Other conditions that utilize the term "lupus" but are not cutaneous lupus erythematosus are also discussed.
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Affiliation(s)
- Elizabeth E. Cooper
- Department of Dermatology, Dell Medical School at the University of Texas, Austin 78701, USA
| | - Catherine E. Pisano
- Department of Dermatology, Dell Medical School at the University of Texas, Austin 78701, USA
| | - Samantha C. Shapiro
- Department of Medicine, Division of Rheumatology, Dell Medical School at the University of Texas, Austin 78701, USA
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37
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Nielens N, Marot L, Baeck M. Sporotrichoid distributed tuberculous panniculitis as a late complication of intravesical Bacillus Calmette-Guérin (BCG) immunotherapy. Int J Infect Dis 2021; 117:247-250. [PMID: 33984512 DOI: 10.1016/j.ijid.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022] Open
Abstract
An 82-year-old man presented with unilateral oedema of the right lower limb overlaid with multiple, sporotrichoid distributed, panniculitis lesions. These symptoms appeared in a context of immunodepression and were associated with significant weight loss and deteriorated general condition. Patient's medical history, the histological findings, PCR testing and bacterial culture led to a diagnosis of cutaneous tuberculosis due to Mycobacterium bovis. This infection occurred as a late complication of intravesical Bacillus Calmette-Guérin (BCG) instillations that the patient had received as an adjunctive immunotherapy for bladder cancer. This is an unusual clinical presentation and aetiology of cutaneous tuberculosis. Indeed, the observed sporotrichoid pattern is uncommon for tuberculous mycobacteria. Moreover, the occurrence of tuberculous skin lesions after intravesical BCG instillations is extremely rare, with only a few cases described, and, to our knowledge, none with such clinical presentation. This case report suggests that a medical history of BCG immunotherapy should always be considered when assessing any infectious-type cutaneous lesions and that skin should be regarded as a possible late localization of infectious complications of this treatment.
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Affiliation(s)
- Nina Nielens
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Liliane Marot
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
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38
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MA, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda JM, Velasco Benito V, Beato Merino MJ, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 2. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00138-1. [PMID: 33891884 DOI: 10.1016/j.ad.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022] Open
Abstract
Part 2 of this series on granulomatous diseases focuses on skin biopsy findings. Whereas the first part treated noninfectious conditions (metabolic disorders and tumors, among other conditions), this part mainly deals with various types of infectious disease along with other conditions seen fairly often by clinical dermatologists.
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Affiliation(s)
- J Aróstegui Aguilar
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Carrillo Gijón
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Fernández Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, España
| | - M Garrido
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - M A Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - A Christian Laga
- Departamento de Patología, Brigham and Women's Hospital, Boston, Massachusetts, Estados Unidos
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - N Martínez Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Sant Joan d'Alacant, Alicante, España
| | - N Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Quirón salud, Sant Cugat del Vallès, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - A Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica. Hospital Universitario Son Espases, Palma de Mallorca, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | - A Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, León, España; Unidad de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
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39
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Kim JW, Yoo JR, Oh H, Kim M, Heo ST. Delayed Diagnosis of Tuberculosis Mistaken for Tinea Corporis in a Healthy Adult. Tuberc Respir Dis (Seoul) 2021; 84:245-246. [PMID: 33853296 PMCID: PMC8273017 DOI: 10.4046/trd.2021.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jae-Wang Kim
- Department of Dermatology, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jeong Rae Yoo
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Hyunjoo Oh
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Misun Kim
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
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40
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Natali D, Cloatre G, Brosset C, Verdalle P, Fauvy A, Massart JP, Vo Van Q, Gerard N, Dobler CC, Hovette P. What pulmonologists need to know about extrapulmonary tuberculosis. Breathe (Sheff) 2021; 16:200216. [PMID: 33664835 PMCID: PMC7910020 DOI: 10.1183/20734735.0216-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Extrapulmonary tuberculosis (EPT) can affect all organs. Its diagnosis is often challenging, especially when the lung is not involved. Some EPT locations, such as when the central nervous system is involved, are a medical emergency, and some have implications for treatment options and length. This review describes clinical features of EPT, diagnostic tests and treatment regimens. Extrapulmonary tuberculosis can affect any organ, can be potentially life threatening or disabling, poses diagnostic difficulties and may change the type and length of treatment. Looking for concomitant pulmonary tuberculosis is essential.https://bit.ly/2YEaRVb
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Affiliation(s)
| | | | | | - Pierre Verdalle
- Ear-Nose-Throat Diseases, Hanoi French Hospital, Hanoi, Vietnam
| | - Alain Fauvy
- Orthopedic Surgery, Hanoi French Hospital, Hanoi, Vietnam
| | | | - Quy Vo Van
- Urology, Hanoi French Hospital, Hanoi, Vietnam
| | - Nelly Gerard
- Dermatology, Hanoi French Hospital, Hanoi, Vietnam
| | - Claudia C Dobler
- Dept of Respiratory Medicine, Liverpool Hospital, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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41
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Kaur T, Arora S, Gandhi G. Chronic foot ulcers – Rule out cutaneous tuberculosis! INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2021. [DOI: 10.4103/ijpd.ijpd_140_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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42
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Asmarani Y, Mulia RC, Adriani A. A large verrucous plaque on the buttocks: a case report of an atypical presentation of tuberculosis verrucosa cutis. Pan Afr Med J 2020; 37:131. [PMID: 33425164 PMCID: PMC7757284 DOI: 10.11604/pamj.2020.37.131.26150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022] Open
Abstract
Although the incidence of cutaneous tuberculosis (TB) has declined among all cases in dermatology outpatient settings, atypical cases are still being reported worldwide. These atypical forms can imitate other conditions hence delaying the diagnosis and increased morbidity. We report a case of an atypical presentation of extensive Tuberculosis Verrucosa Cutis (TVC) on the buttocks presenting as an annular hyperkeratotic plaque with central healing. Suspicious clinical manifestations and histopathological features followed by an excellent response with antituberculosis therapy confirmed the diagnosis of TVC. Recalcitrant chronic lesions even with adequate standard treatment should raise suspicion of cutaneous TB, especially in endemic areas.
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Affiliation(s)
- Yulia Asmarani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Hasanuddin, South Sulawesi, Makassar, Indonesia
| | - Rizki Citra Mulia
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Hasanuddin, South Sulawesi, Makassar, Indonesia
| | - Anni Adriani
- Dr. Wahidin Sudirohusodo Hospital, South Sulawesi, Makassar, Indonesia
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43
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Killian M, Habougit C, Monard E, Gramont B. Systemic sarcoidosis revealed by venepunctures: a very rare but rewarding cutaneous manifestation. BMJ Case Rep 2020; 13:13/9/e235784. [PMID: 32900730 DOI: 10.1136/bcr-2020-235784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 67-year-old man was referred to our department for the onset of cutaneous lesions following venepunctures. His recent medical history included brief flu-like syndrome, persistent cough, dyspnoea, dry mouth, blurred vision and weight loss. The extensive clinical, biological and radiological check-up showed signs consistent with systemic sarcoidosis: right uveitis, hypercalcemia, renal failure, inflammatory syndrome, elevated levels of ACE, alveolitis with elevated CD4+/CD8+ T cell ratio, hilar and mediastinal lymphadenopathy, bilateral pulmonary infiltrates, mild bronchial obstruction and lowered diffusing capacity of the lungs for carbon monoxide. Multiple biopsy samples (bronchus, accessory salivary glands and one of the skin lesions) eventually confirmed the diagnosis. Corticosteroids resulted in skin lesions resolution in a few days and overall clinical, biological and lung function improvement. The infiltration of scars by granulomatous tissue is well recognised in sarcoidosis but its onset in venepuncture sites is a very rare but easily recognisable condition, which can be helpful for quick diagnosis purpose.
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Affiliation(s)
- Martin Killian
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Loire, France .,GIMAP, Université Jean Monnet Saint-Etienne, Saint-Etienne, Loire, France
| | - Cyril Habougit
- Laboratory of Pathology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Loire, France
| | - Eric Monard
- Department of Internal Medicine, Centre Hospitalier Chalon sur Saone, Chalon-sur-Saone, France
| | - Baptiste Gramont
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Loire, France
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44
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[A chronic wound from Vietnam]. Hautarzt 2020; 71:443-446. [PMID: 32356072 DOI: 10.1007/s00105-020-04597-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Chronic skin lesions that occur in patients who have previously stayed in tropical countries pose a diagnostic challenge for physicians. In particular, if there is a granulomatous inflammatory reaction histologically, infectious diseases should also be included in the differential diagnosis. Particularly in persons returning from high-risk regions such as Vietnam, this includes cutaneous tuberculosis, which entails a thorough examination of the patient and comprehensive therapy. This case study shows which steps should be considered if cutaneous tuberculosis is suspected.
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45
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Mohanlal R, Reddy DL. Spectrum of HIV-associated infectious diseases: A case series through the eyes of the histopathologist. South Afr J HIV Med 2020; 21:1087. [PMID: 32670628 PMCID: PMC7343954 DOI: 10.4102/sajhivmed.v21i1.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infection increases the risk of infection by a host of other opportunistic pathogens. The clinical presentations of these co-infections in immunocompromised patients are often atypical; therefore diagnosis is delayed in the absence of investigations such as tissue biopsy. Infection may involve sites that are difficult to access for biopsy and, as a consequence, there is limited diagnostic tissue available for analysis. The histopathologist, aided by ancillary tests, is relied upon to make a timeous and accurate diagnosis. Objectives To illustrate key histological features of HIV-associated infectious diseases encountered in a histopathology laboratory and to highlight, with the aid of literature, the relevance of histopathology in diagnosis. Method A retrospective descriptive case series of biopsies histologically diagnosed with HIV-associated infectious diseases over four years (2015–2019) was performed at the Chris Hani Baragwanath Academic Hospital National Health Laboratory Services Histopathology department. These cases have been photographed to illustrate microscopic aspects and will be accompanied by a literature review of opportunistic infections in the context of HIV infection. Results This article highlights aspects of fungal, parasitic, viral and selected bacterial infections of people living with HIV for whom the histopathological examination of tissue was an essential component of the clinical diagnosis. Histological features are noted on routine slides and accompanied by diagnostic features revealed with histochemical and immunohistochemical stains. Conclusion Medical practitioners working in areas of high HIV endemicity should be familiar with the variety of infectious diseases that are encountered and with the diagnostic importance of the histopathologist in clinical management.
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Affiliation(s)
- Reena Mohanlal
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Denasha L Reddy
- Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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46
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van Staden D, du Plessis J, Viljoen J. Development of a Self-Emulsifying Drug Delivery System for Optimized Topical Delivery of Clofazimine. Pharmaceutics 2020; 12:E523. [PMID: 32521671 PMCID: PMC7356627 DOI: 10.3390/pharmaceutics12060523] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 11/24/2022] Open
Abstract
A quality-by-design and characterization approach was followed to ensure development of self-emulsifying drug delivery systems (SEDDSs) destined for topical delivery of the highly lipophilic clofazimine. Solubility and water-titration experiments identified spontaneous emulsification capacity of different excipient combinations and clofazimine. After identifying self-emulsification regions, check-point formulations were selected within the self-emulsification region by considering characteristics required to achieve optimized topical drug delivery. Check-point formulations, able to withstand phase separation after 24 h at an ambient temperature, were subjected to characterization studies. Experiments involved droplet size evaluation; size distribution; zeta-potential; self-emulsification time and efficacy; viscosity and pH measurement; cloud point assessment; and thermodynamic stability studies. SEDDSs with favorable properties, i.e., topical drug delivery, were subjected to dermal diffusion studies. Successful in vitro topical clofazimine delivery was observed. Olive oil facilitated the highest topical delivery of clofazimine probably due to increased oleic acid levels that enhanced stratum corneum lipid disruption, followed by improved dermal clofazimine delivery. Finally, isothermal microcalometric experiments studied the compatibility of excipients. Potential interactions were depicted between argan oil and clofazimine as well as between Span®60 and argan-, macadamia- and olive oil, respectively. However, despite some mundane incompatibilities, successful development of topical SEDDSs achieved enhanced topical clofazimine delivery.
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Affiliation(s)
| | | | - Joe Viljoen
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom, North-West Province 2520, South Africa; (D.v.S.); (J.d.P.)
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Bourlond F, Velter C, Lipsker D. [A case of cutaneous tuberculosis evolving for 50 years]. Ann Dermatol Venereol 2020; 147:653-657. [PMID: 32386803 DOI: 10.1016/j.annder.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/29/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tuberculosis is an infection caused by Mycobacterium (M.) tuberculosis. It is rare in France. Clinical presentations vary, making demonstration of the cause of M. Tuberculosis difficult and rendering diagnosis and management difficult. PATIENTS AND METHODS A 58-year-old man, born in Morocco, consulted for ulceration of the right forefoot that had been present since the age of 3 years. He had previously consulted at several dermatology departments. He had undergone numerous skin biopsies and bacteriological and mycobacteriological cultures but these did not contribute to the diagnosis. Slow extension and oozing were observed over time and resulted in functional disability. Given the evocative clinical aspect and despite further negative screening for mycobacteria, anti-TB quadrotherapy was prescribed and resulted in complete cure of the lesion. DISCUSSION This case underscores the difficulty of diagnosing cutaneous tuberculosis. Such a diagnosis must be clinically suspected in the presence of long lasting destructive or verrucous skin lesions that fail to heal, even where cultures are negative, and anti-TB therapy should be putatively prescribed.
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Affiliation(s)
- F Bourlond
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - C Velter
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - D Lipsker
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Karadag AS. Commentary: Great imitators in dermatology: II. Clin Dermatol 2019; 38:137-139. [PMID: 32513394 DOI: 10.1016/j.clindermatol.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ayse Serap Karadag
- Department of Dermatology and Venereology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
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Affiliation(s)
- Ayşe Serap Karadağ
- Department of Dermatology and Veneorology, Istanbul Medeniyet University, Istanbul, Turkey.
| | - WenChieh Chen
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
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