Background: In the past years the incidence of tuberculosis has dropped significantly in most parts of Europe and the presentation of symptomatic tuberculosis cases have become increasingly rare. With the recent influx of refugees in Europe coming from tuberculosis endemic areas like the Middle East and Africa, it is expected that the incidence of tuberculosis will increase.
Objectives: Cutaneous symptoms are important hallmarks that can be of aid for the correct diagnosis of an underlying disease, like tuberculosis. Read More
Cutaneous tuberculosis can be classified as true cutaneous tuberculosis and tuberculids which is regarded as a hypersensitivity reaction to M. tuberculosis in patients with a high degree of tuberculin sensitivity. Papulonecrotic tuberculid (PNT) is a form of tuberculid. Read More
Departments of *Pathology, and †Dermatology and STD, University College of Medical Sciences and associated GTB Hospital, Delhi, India; and ‡Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Delhi, India.
Background: Although cutaneous tuberculosis (CTB) is well described, it is wise to periodically revisit the prevailing clinical and epidemiological features, of this somewhat uncommon entity in developed nations that is also usually neglected in national tuberculosis control programs in countries where tuberculosis is a major health problem, to maintain heightened awareness as the HIV pandemic runs its course.
Methods: Medical records of 165 cases of CTB, diagnosed from 2007 to 2010, were studied. The diagnosis in each was made on the basis of well-conceived and described criteria. Read More
Background/objectives: The clinical and histopathologic findings of a rare simultaneous occurrence of papulonecrotic tuberculid and nodular tuberclid in a patient with active but asymptomatic pulmonary tuberculosis are presented. Papulonecrotic tuberculid was observed at a very early stage, presenting as molluscum-like lesions. This has been described once in the literature. Read More
Background: Papulonecrotic tuberculid (PNT) is said to be a hypersensitivity reaction to M. tuberculosis. Some reports indicate that organisms are demonstrable by polymerase chain reaction (PCR). Read More
A case is reported of a patient presenting lymph node tuberculosis and cutaneous lesions resembling papulonecrotic tuberculid, but histologically compatible with perforating granuloma annulare and which responded satisfactorily to antituberculous therapy. This is probably one of the first reports of the association of perforating granuloma annulare and tuberculosis, and it is important therefore to highlight the relevance of this disorder in the differential diagnosis of papulonecrotic tuberculid and to raise the hypothesis that this entity should also be considered to be a variant of tuberculid. Read More
A 65-year-old man presented with multiple asymptomatic papulo-pustules and ulcers over glans penis since last 1 year. The lesions used to resolve spontaneously in a few days with scarring. The clinical features and histopathology were suggestive of papulonecrotic tuberculids of the glans penis. Read More
A 12-year-old girl was seen with widespread millimetric papules which resolved leaving varioliform scars. Tuberculin test was strongly reactive. Underlying pulmonary tuberculosis was diagnosed. Read More
Introduction: The present study aimed to establish the frequency and clinical characteristics of cutaneous tuberculosis among Mexican adult patients.
Methodology: Ninety-five patients with clinically compatible lesions to cutaneous tuberculosis participated in the study. All patients were HIV negative and none of them had previous anti-TB treatment. Read More
Although papulonecrotic tuberculid is an uncommon cutaneous manifestation of tuberculosis (TB) associated with Mycobacterium tuberculosis infection, the simultaneous occurrence of papulonecrotic tuberculid and erythema induratum is even rarer. Papulonecrotic tuberculid occurs predominantly in young adults and is characterized by eruptions of necrotizing papules that heal with varioliform scars. Histopathologic findings include wedge-shaped necrosis of the dermis, poorly formed granulomatous infiltration, and vasculitis. Read More
Extrapulmonary tuberculosis constitutes about 10% of all cases of tuberculosis, and cutaneous tuberculosis makes up only a small proportion of these cases. Despite prevention programs, tuberculosis is still progressing endemically in developing countries. Commonest clinical variant of cutaneous tuberculosis in our study was lupus vulgaris seen in 55% patients followed by scrufuloderma seen in 25% patients followed by orificial tuberculosis, tuberculosis verrucosa cutis, papulonecrotic tuberculid, and erythema induratum seen in 5% each. Read More
Papulonecrotic tuberculid is a rare, chronic, recurrent and symmetric eruption of necrotizing skin papules arising in crops, involving primarily the limbs. It occurs in less than 5% of active tuberculosis. Typically bacilli are not detected in any of the cutaneous lesions. Read More
The tuberculids are a group of rare cutaneous hypersensitivity reactions that occur in response to a distant focus of mycobacterial infection. Typically, Mantoux testing is strongly reactive, and clinical response to antituberculous treatment is rapid. The papulonecrotic subtype is one such clinical variant, consisting of multiple symmetrical papules, often with central necrosis, distributed preferentially over the trunk and limbs. Read More
Background And Objectives: There are few reports of cutaneous tuberculosis with immunosuppressed states such as HIV, use of immunosuppressants or malignancy. Diagnosis is thus difficult and despite scientific advances such as polymerase chain reaction, it is frequently missed. Although rare, given its worldwide prevalence and the rising incidence of HIV, it is important for clinicians to recognize the variants and promptly treat the patient. Read More
A 31-year-old Moroccan woman with no significant past medical history was seen during her second pregnancy. At 25 weeks gestation she was admitted with a febrile illness associated with a productive cough which was treated as a community acquired pneumonia with oral antibiotics. At 31 weeks gestation she was admitted with a tender swelling in the right groin and underwent incision and drainage of a presumed femoral abscess. Read More
Papulonecrotic tuberculids represent an immunological expression of an internal focus of tuberculosis in an individual with a moderate or high degree of immunity. It responds to anti-tuberculosis treatment and is characterized by an eruption of necrotizing papules occurring in symmetrical crops, particularly affecting the elbows, knees, buttocks and face. A case of papulonecrotic tuberculids associated with immune mediated unilateral uveitis is reported in which all investigations were negative for tuberculosis except a strongly positive tuberculin test. Read More
Localized tuberculid has been infrequently reported in the literature. Most of these reports are of papulonecrotic tuberculids localized to the penis, an entity designated as "penis tuberculid." In females, such a localized genital tuberculid has not been documented till date. Read More
Background: Tuberculids are rarely associated with male genital tract tuberculosis (TB). Tuberculous epididymo-orchitis (TBEO) has been associated rarely with papulonecrotic tuberculid (PNT) but not with erythema induratum (EI) or the simultaneous occurrence of different tuberculids.
Methods: A retrospective assessment of tuberculids that occurred with underlying TBEO was carried out. Read More
We present a 33-year-old HIV-positive man who presented with a two-year history of a non-itchy papular eruption, associated with night sweats, headaches, poor memory and weight loss. On examination, he had erythematous papular lesions with necrotic centres on the face, arms and torso with no systemic abnormalities. A skin biopsy eventually led to the diagnosis of papulonecrotic tuberculid, and treatment with quadruple therapy resulted in resolution of his rash and systemic symptoms. Read More
Three cases of tuberculosis of the penis are reported. The first two cases were papulonecrotic tuberculids over the glans penis and the third case was tuberculous ulcer of the penis. In the first 2 cases, no focus of tuberculosis infection could be detected. Read More
A 25-year-old male presented with an asymptomatic papulo-pustular eruption over the glans penis. The clinical features and investigations were suggestive of papulonecrotic tuberculids of the glans penis. He had an underlying bilateral active tuberculous epididymo-orchitis and a healed focus of pulmonary tuberculosis. Read More
A 40 years old male patient of poor socioeconomic condition presented with a well circumscribed rough surfaced and fissured, verrucous plaque on left axilla and a similar lesion on right foot- which were clinically diagnosed as tuberculosis verrucosa cutis. He also had necrotic papular eruption with varioliform scarring in some lesions on upper back clinically diagnosed as papulonecrotic tuberculid. He had fever and cough and mild weight loss suspicious of pulmonary tuberculosis. Read More
One of the specific skin lesions occurring after Bacille Calmette-Guerin (BCG) vaccination is generalized tuberculid-like eruptions, which occur rarely, but have a tendency to heal spontaneously. Their pathogenesis and relationship to "true" tuberculids are poorly understood. This report presents a case of a 6-month-old girl who developed generalized papulonecrotic tuberculid-like eruptions after BCG vaccination. Read More
Background And Objectives: Resurgence of tuberculosis (TB) in the era of human immunodeficiency virus (HIV) has rejuvenated the interest in this global health problem. Cutaneous TB, an important extra-pulmonary form in children, is commonly seen in our dermatological practice. As detection of acid-fast bacillus (AFB) on smear or culture is not always positive, histopathology is necessary to help in diagnosing and classifying the variants of skin TB. Read More
Background: Tuberculides are the result of immunologic reactions to hematogenously spread antigenic components of Mycobacterium tuberculosis. There are three recognized tuberculides--papulonecrotic tuberculide, erythema induratum of Bazin, and lichen scrofulosorum. In 1997, in Japan, Hara and coworkers reported five patients with what they called "nodular granulomatous phlebitis," which they proposed was a fourth type of tuberculide. Read More
Background: Cutaneous tuberculosis forms a small subset of extrapulmonary tuberculosis. The present study is an attempt to observe the clinico morphological pattern seen in cases of cutaneous tuberculosis over a period of 5 years, and to correlate them with mantoux reactivity and human immunodeficiency virus (HIV) status.
Methods: All cases of cutaneous tuberculosis observed among the dermatology in patients and those attending out patient department were included in the study. Read More
Mycobacterium tuberculosis (TB) infection of the penis is a rare but serious problem. We report a case of penile TB in a 75-year-old man who presented with fever and dyspnea. No active lung lesions except pleural and pericardial effusion were found on chest X-ray. Read More
We describe a 62-year-old Japanese woman who had skin lesions involving her extremities, chest and back that showed spontaneous remission. The skin lesions consisted of slightly atrophic scars and crusted, reddish or necrotic papules. A tuberculin test showed induration and bulla, which was regarded as strongly positivity. Read More
Papulonecrotic tuberculid (PTB) is a form of cutaneous tuberculosis with characteristic clinical and histological manifestations. The incidence of PNT is very low in Spain. We present the case of a 22-year-old male patient from a middle-class social and economic background, with clinical and histological criteria of PNT, but who showed negative for molecular traces of mycobacteria using PCR. Read More
A 21-year-old patient with a history of drug addiction presented with generalized, centrally-ulcerated papules and haemorrhagic crusts. Initially, differential diagnostic considerations included pityriasis lichenoides et varioliformis acuta and syphilis. Biopsy and serological testing confirmed the latter diagnosis. Read More
We describe a case of papulonecrotic tuberculid, a rare form of cutaneous tuberculosis, in a 25-year-old Philippino woman who had immigrated to Canada 8 years previously. The patient presented with a 3-week history of tender left cervical adenopathy; 1 week later, she developed multiple ulcerated erythematous nodules and emboluslike lesions scattered over her fingers. Results of a biopsy performed on the lymph node revealed granulomatous lymphadenitis, and Mycobacterium tuberculosis grew from the lymph node. Read More
Tuberculids (papulonecrotic tuberculid, erythema induratum, and lichen scrofulosorum) are cutaneous hypersensitivity reactions to Mycobacterium tuberculosis . We report the fifth case of a recently described tuberculid, nodular tuberculid. The distinguishing feature was that of a granulomatous vasculitis occurring at the dermohypodermal junction on biopsy specimen of the subcutaneous nodules. Read More
A 50-year-old Thai woman presented with papulonecrotic tuberculid-like eruptions on her back and inframammary area with fever, nonproductive cough and weight loss. Chest radiograph showed diffuse bilateral reticulonodular opacities in both lungs with bilateral hilar lymph node enlargement. High resolution computed tomography (HRCT) of the lungs showed peribronchovascular interstitial thickening with multiple lymph nodes enlargement. Read More
We experienced a rare case of papulonecrotic tuberculide (PT). A twenty-four year old female was referred to our hospital because she had had an eruption for the last for four years. Her chest X-ray revealed no abnormal shadow three years ago when her eruption had already appeared. Read More
As we move into the 21st century, cutaneous tuberculosis has re-emerged in areas with a high incidence of HIV infection and multi-drug resistant pulmonary tuberculosis. Mycobacterium tuberculosis, Mycobacterium bovis, and the BCG vaccine cause tuberculosis involving the skin. True cutaneous tuberculosis lesions can be acquired either exogenously or endogenously, show a wide spectrum of morphology and M. Read More
Papulonecrotic tuberculid (PNT), a cutaneous manifestation of tuberculosis, is rare even in areas endemic for tuberculosis such as Taiwan. Concomitant pulmonary tuberculosis is uncommon in patients with PNT. We describe a patient with rare skin manifestations and simultaneous pulmonary tuberculosis. Read More