Cutaneous tuberculosis: diagnosis, histopathology and treatment - Part II

Abstract

The evolution in the knowledge of tuberculosis' physiopathology allowed not only a better understanding of the immunological factors involved in the disease process, but also the development of new laboratory tests, as well as the establishment of a histological classification that reflects the host's ability to contain the infectious agent. At the same time, the increasing bacilli resistance led to alterations in the basic tuberculosis treatment scheme in 2009. This article critically examines laboratory and histological investigations, treatment regimens for tuberculosis and possible adverse reactions to the most frequently used drugs.

Lichen Scrofulosorum in a Patient with Tuberculous Cervical Lymphadenopathy: A case report

“…Normally giant cells are absent and acid-fast bacilli are not found [3,4,6]. Tubercle bacilli are almost never seen in the biopsy specimen and they cannot be cultured [4,6,11]. A possible explanation is that they are present in a fragmented form or have been destroyed by immunological mechanisms [13].…”

“…Following anti-TB treatment, the lesions usually clear within 4 to 12 weeks without scarring [6,10,11,15,16].…”

Cutaneous and articular tuberculosis in a renal transplant recipient

“…TB abscesses typically affect malnourished children and immunocompromised adults, including patients receiving SOTs and are rarely reported in immunocompetent patients 7 . The detection of bacilli in cutaneous lesions is a true challenge: on average, all diagnostic methods have lower sensitivity and specificity rates compared to those observed in the pulmonary form of the disease 8 . Histopathological examination is essential to establishing a diagnosis.…”

“…Cultures for bacteria, mycobacteria, and fungus yielded negative results. Almost all clinical presentations of TB have a similar histological basis, which includes histiocytes and giant cells, and the histological differences in each patient result from the host's ability to organize the granulomatous processes 8 . When confronted with the possible diagnosis of cutaneous TB, a chest radiograph should always be ordered, as it is sometimes possible to detect active pulmonary TB in these patients.…”

“…Many reports claim that latent TB treatment with isoniazid for chemoprophylaxis during dialysis is effective in post-transplant patients with a positive TST test 9,10 . Nonetheless, a thorough medical history must be obtained from the family and the patient, and patients on dialysis should be submitted to a TST or an interferon-gamma release assay, if possible 8 . Most experts agree that the primary therapy for latent TB should include isoniazid for 6 to 9 months 1,11,12 .…”