Multiple metastatic tuberculous abscesses in a severely malnourished infant

[Cutaneous tuberculosis affecting the buttock in an immunocompetent adult patient]

La tuberculose est une maladie endémique au Sénégal. Les formes cutanées sont rares et se caractérisent par leur polymorphisme clinique. Elles représentent 2% des localisations extra pulmonaires de la tuberculose. Nous rapportons l'observation d'une gomme tuberculeuse de la fesse révélant une localisation pulmonaire active chez un adulte immunocompétent. Un homme âgé de 47 ans fut admis pour une tuméfaction douloureuse de la fesse droite évoluant depuis quatre ans. L'examen physique notait un placard induré et polyfistulisé fait de nodules confluents avec une émission de pus jaunâtre, siégeant à la face inférointerne de la fesse droite, associé à des adénopathies inguinales bilatérales d'allure inflammatoire. Une tuberculose cutanée était retenue devant l'histologie qui montrait un granulome tuberculoïde et la recherche de BAAR dans le liquide de tubage gastrique qui était positif. La tomodensitométrie thoraco-abdominopelvienne avait montré de multiples micronodules pulmonaires acinaires basals bilatéraux. Les sérologies VIH et VHB étaient négatives. Une guérison était obtenue six mois après un traitement antituberculeux. La tuberculose cutanée se caractérise par son polymorphisme clinique en zone d'endémie. Elle doit aussi être cherchée devant tout placard d’abcès du périnée.

Concomitant cutaneous metastatic tuberculous abscesses and multifocal skeletal tuberculosis

Tuberculosis, one of the oldest diseases known to affect humans is caused by the bacteria mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one third of cases, other organs are involved. Metastatic tuberculosis abscess is a rare form of skin tuberculosis. It is characterized by nodule and abscess formation throughout the body after hematogenous spread of mycobacterium tuberculosis from a primary focus during a period of impaired immunity. Tuberculosis osteomyelitis is also a rare form of extrapulmonary tuberculosis in pediatric age group. Skeletal tuberculosis pathogenesis is related to reactivation of hematogenous foci or spread from adjacent paravertebral lymph nodes. Weight-bearing joints are affected most commonly. Bilateral hand and foot bone involvement is rarely reported. We present a five-year-old girl with two very rare presentations of the disease such as osteomyelitis and metastatic skin abscess.

Abcès tuberculeux métastatiques (gommes tuberculeuses) : un diagnostic rare en France

INTRODUCTION

Cutaneous tuberculosis is rare in the developed countries. We report a case of tuberculous gumma in an immunocompetent patient diagnosed late.

CASE-REPORT

A 33-year-old Moroccan woman was diagnosed with tuberculous gumma after presenting cutaneous nodules and subcutaneous abscesses that had developed during pregnancy and were present for 11 months. Cutaneous and pulmonary tuberculosis was discovered. The patient recovered under antimycobacterial treatment.

COMMENTS

Cutaneous tuberculosis presents with a wide spectrum of clinical lesions. It should be considered in the presence of poorly known lesions such as gumma, which require investigation for underlying tuberculosis.

Multiple metastatic tuberculosis abscesses in a patient with Pott disease and lung tuberculosis: a case report

The incidence of tuberculosis in Western countries is rising, and continued vigilance together with an awareness of its protean manifestations is essential. Cutaneous tuberculosis is a relatively rare manifestation of the disease, accounting for only 1% of extrapulmonary cases of tuberculosis and 0.14% of all reported cases of tuberculosis. A 19-year-old male patient was admitted to our clinic with skin lesions both at the front and at the back of his body. With clinical findings, histopathology, polymerase chain reaction, PA lung graph, and computerised tomography, the patient was diagnosed with metastatic tuberculosis abscess associated with lung tuberculosis and Pott's disease. Antituberculosis drugs were administered. An increased awareness of the re-emergence of cutaneous tuberculosis will allow for the proper diagnosis and management of this increasing common skin disorder.

Metastatic tuberculous abscesses in an immunocompetent patient

The decreased incidence of infectious diseases in developed countries may make their diagnosis difficult. Cutaneous tuberculosis is an example of this fact. A 44-year-old man presented with two painful abscesses on his lower extremities, which developed into chronic ulcers. A cutaneous biopsy revealed necrotizing granulomas in the dermis. Ziehl-Neelsen and periodic acid-Schiff stain were negative. Mantoux test was positive. Tc-99m scintigraphy showed increased uptake in the bone tissue of the left ankle and right tibiae, without direct relation to cutaneous lesions. Chest X-ray showed micronodular, apical, bilateral infiltrates, reduced volume of the right lung, and cavitation of the right superior lobe. Mycobacterium tuberculosis was grown from sputum and skin biopsy samples. Isoniazid, rifampin and pyrazinamide treatment for 2 months, followed by isoniazid and rifampin for 12 months, resulted in complete resolution. The clinical features of cutaneous tuberculosis in our patient were characteristic of tuberculous abscesses. Some uncommon findings, such as the low number of lesions, negative acid-fast resistant stains in cutaneous biopsy samples and his preserved general state of health, may be explained by a higher competence of the immune system than is usual in this clinical subset of disseminated tuberculosis. Cutaneous tuberculosis should be included in the differential diagnosis of cutaneous abscesses in immunocompetent patients.