A Case of Tuberculous Granulomatous Panniculitis without Vasculitis

Abstract

We report a case of tuberculous granulomatous panniculitis without vasculitis in an 87-year-old female patient with B-cell chronic lymphocytic leukaemia. One month after starting chemotherapy with chlorambucil and prednisone she presented superficial erythematous plaques on the anterior side of the left leg. Three weeks later erythematous painless deep nodules appeared on the left popliteal fossa and on the left thigh. Cutaneous biopsy revealed granulomatous panniculitis without caseation necrosis or vasculitis. Polymerase chain reaction for Mycobacterium tuberculosis revealed positivity in the skin. The final diagnosis was reactivation of latent tuberculosis (TB) induced by deep immunosuppression associated with chemotherapy and haematological disease. Tuberculous granulomatous panniculitis without vasculitis is a rare presentation of cutaneous TB and may be part of the heterogeneous histopathologic spectrum of erythema induratum of Bazin (nodular vasculitis). Our case shows that the diagnosis of cutaneous TB requires the correlation of clinical findings with histopathology and microbiological tests.

Cutaneous Manifestations of Mycobacterium tuberculosis: A Literature Review

“…However, a case study was performed in 2017 that utilized topical application of anti-TB drugs for the treatment of erythema induratum, a chronic recurrent lobular panniculitis commonly associated with TB infection. More specifically, tuberculous granulomatous panniculitis without vasculitis is a rare presentation of CTB that requires the correlation of clinical findings with histopathology and microbiological tests to confirm the diagnosis [ 56 ]. In this study, 15 tablets of 1500 mg isoniazid were crushed and mixed with 40 g zinc oxide ointment, creating a 3.75% topical anti-TB cream.…”