Lichen scrofulosorum in a Saudi adolescent with multifocal tuberculosis

Abstract

M Enani, Lichen Scrofulosorum in a Saudi Adolescent with Multifocal Tuberculosis. 2008; 28(3): 213-216 Lichen scrofulosorum (LS) is a rare form of cutaneous tuberculosis (TB) that affects children and young adults. It is ascribed to hematogenous spread of Mycobacteria in an individual strongly sensitive to Mycobacterium tuberculosis.2 The skin lesions are typically symptomless papular eruptions, associated with a strong Mantoux reaction or with TB of the lymph nodes and/or other organs.3 The response to anti-TB therapy is usually striking. The objective of this paper is to report LS for the first time in Saudi Arabia. It is an exceptionally rare type of cutaneous tuberculosis, and this account emphasizes the importance of excluding underlying systemic TB. CASEA 13-year-old, previously healthy Saudi Arabian adolescent male was hospitalized in a tertiary care hospital for investigation of a persistent non-itchy skin rash for one month associated with mild non-productive cough. He reported anorexia and had lost 7 kilograms body weight over the preceding four months; however his illness did not affect his performance at school. There were no musculoskeletal, gastrointestinal, or ophthalmologic symptoms. He had no recent travel and no known exposure to animals. He had received Bacille Calmette-Guêrin (BCG) vaccination as a neonate and other vaccinations were up-to-date. The patient's mother had been treated for pulmonary tuberculosis three years earlier. Clinical examination revealed a pale, malnourished patient with a body weight of 33 kilograms and a height of 150 centimeters. He had fever of unknown origin (FUO). Skin examination revealed discrete symmetrical red-brown papules (5 to 10 mm) on the trunk and proximal limbs, some of which were crusted and covered by whitish scales (Figure 1). The face, mucous membranes and genitalia were not involved. There were non-tender and discrete cervical and inguinal lymphadenopathies less than 2 centimeters in size. The remainder of a full systematic examination was unremarkable. Laboratory investigations revealed a leukocyte count of 8.7 x 10 9 /dL, hemoglobin 10 g/dL, platelets of 254x10 9 /L, erythrocyte sedimentation rate 60 mm, albumin 31 g/L, alkaline phosphatase 732 U/L (normal range, 98 to 279 U/L). The liver enzymes and renal function tests were normal. The patient was tested for HIV, hepatitis B and C and found to be non-reactive. Serology for Epstein-Barr virus IgG antibody was positive, while cytomegalovirus and varicella-zoster antibodies were negative; antinuclear antibody and rheumatoid factor tests were also negative. Multiple cultures of induced sputum were negative for M tuberculosis. Blood cultures were sterile. A purified protein derivative (PPD) tuberculin skin test with 5 units was negative. A radiograph of the chest showed a widened mediastinum, and a CT of the chest revealed a grossly enlarged bilateral paratracheal, pretracheal, and mediastinal lymphadenopathy (Figure 2). Abdominal CT showed bulky, poorly enhancing porta hepatis lymphadenopathy wit...

Pyranoside‐into‐Furanoside Rearrangement of 4‐Pentenyl Glycosides in the Synthesis of a Tetrasaccharide‐Related to Galactan I of Klebsiella pneumoniae

“…The Gram‐negative bacterium Klebsiella pneumoniae is responsible for different diseases including pneumonia, bacteremia, urinary‐tract infections, and pyogenic liver abscess with high incidence and mortality , . This bacterium is a frequent cause of nosocomial infections, and may be responsible for as much as 20 % of respiratory infections in neonatal intensive care units…”

“…The Gram-negative bacterium Klebsiella pneumoniae is responsible for different diseases including pneumonia, bacteremia, urinary-tract infections, and pyogenic liver abscess with high incidence and mortality. [1,2] This bacterium is a frequent cause of nosocomial infections, and may be responsible for as much as 20 % of respiratory infections in neonatal intensive care units. [3] The most common serotype of K. pneumoniae O1 [4] has two O antigens: galactan I (repeating unit: [→3)-α-D-Galp-(1→3)--D-Galf-(1→]) and galactan II (repeating unit: [→3)-α-D-Galp-(1→3)--D-Galp-(1→]).…”