Papulonecrotic Tuberculid in a 2‐Year‐Old Girl: With Emphasis on Extent of Disease and Presence of Leucocytoclastic Vasculitis

Ramdial, Pratistadevi K.; Mosam, Anisa; Mallett, Renèe; Aboobaker, Jamila

doi:10.1111/j.1525-1470.1998.tb01393.x

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…While a biopsy of a papulonecrotic tuberculid was also described as ulcerative clinically in the present study, it lacked acid fast bacilli. This was congruent with the concept of tuberculids that, by definition, lack mycobacteria on histopathological appraisal and microbiological culture [34,51]. Tuberculids are cutaneous hypersensitivity tuberculous reactions in patients with visceral TB, and include papulonecrotic tuberculid, lichen scrofulosorum, erythema induratum, nodular granulomatous phlebitis and nodular tuberculid [31,33,34,52].…”

Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (supporting

confidence: 61%

“…In the present study, all biopsies from clinical ulcerative lesions had a microscopic zonation pattern ( Figure 5A). Whilst such a zonation pattern has not been described in vulval tuberculous ulcers, to date, it is described in the walls of tuberculous pulmonary cavities and in papulonecrotic tuberculid [22,31,34,51]. In the present study, acid fast bacilli were identified in the zoned ulcerative inflammatory lesions in the vulva.…”

Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (contrasting

confidence: 39%

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Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Gb¹,

Ramdial²,

Nargan³

et al. 2017

J AIDS Clin Res

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Objective: Vulval tuberculosis (TB) is reported rarely. The histomorphological spectrum and diagnostic mimicry thereof in patients with concomitant HIV infection/ AIDS is unreported to date. This study aimed to appraise the histopathologic spectrum of vulval TB in HIV co-infected patients and to identify histopathological diagnostic challenges, mimicry and pitfalls.Methods: Ten year retrospective study that reappraised the histomorphological features of vulval TB in HIV-infected patients. Results:The clinical descriptions of the biopsied lesions from 19 patients that form the study cohort encompassed nodules (9), ulcers (5), hypertrophy/edema (3) and abscesses (2). The main microscopic features included necrotizing and non-necrotizing granulomatous inflammation, ulceration with a zoned inflammatory response and chronic suppurative inflammation. The necrotizing component had the typical morphology of caseative necrosis or of suppuration/karyorrhexis or an admixture of both necrosis types. Vasculitis, of varied histomorphology, was present in 15 biopsies. Infective special stains were pivotal diagnostic tools. The presence of mycobacteria on Ziehl Neelsen stains (ZNs) and absence of nonmycobacterial infective agents on additional infective stains, underpinned TB diagnosis, especially in biopsies that lacked prototypical granulomatous inflammation or of infective mimickers that manifest with a granulomatous phenotype. ZNs also confirmed mycobacteria in vasculitic foci. The absence of mycobacteria on ZNs facilitated the diagnosis of tuberculids. Conclusion:Lesions with a common clinical appearance had heterogeneous histomorphological features, while lesions with common histopathological features demonstrated divergent clinical morphology. Infective, especially Ziehl Neelsen, stains are pivotal in the histopathological work-up of infective/inflammatory vulval biopsies. It is possible that the rarely reported anergic mononuclear or abscessing features, pseudotumoral spindle cell reactions, ulcers with a zoned inflammatory response and the presence of vasculitis of varied type, are clues to the HIV-TB tissue partnership. Increased clinicopathological investigation of and reporting on vulval TB in the HIV/AIDS afflicted population is pivotal to ascertain this.

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Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (supporting

confidence: 61%

Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (contrasting

confidence: 39%

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Gb¹,

Ramdial²,

Nargan³

et al. 2017

J AIDS Clin Res

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“…9,10 In children, the vulvar and perineal areas may be affected. 26 Until the present case, PNT in the scalp had not been reported.…”

Section: Discussionmentioning

confidence: 64%

“…4,5,11 In children, vascular changes are uncommonly observed, 24 but have been reported. 26 In some cases, vessel recanalization may occur, 11,25 and a wedge-shaped necrosis area with a broad base towards the epidermis, 4,11,18 surrounded by epithelioid and giant cells, is seen. A histiocytic palisade similar to that of granuloma annulare may be seen.…”

Section: Discussionmentioning

confidence: 99%

Papulonecrotic tuberculid on the scalp

et al. 2008

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A 39‐year‐old woman was referred with a 1‐year history of a 4‐cm mass of the left axilla, compatible with a lymph node. Itchy red papules that evolved to crusty lesions and subsequently showed varioliform atrophic scarring appeared over the face, extensor surface of the arms, back, thighs, and scalp (Figs 1 and 2). Her history included weight loss of 8 kg, but no other associated symptoms or contact with tuberculosis patients. The blood count showed a normochromic–normocytic anemia with an erythrocyte sedimentation rate (ESR) slightly elevated at 28 mm in the first hour (normal, < 20 mm). Tuberculin skin test was positive (13 mm with necrotic reaction) and anti‐human immunodeficiency virus serology was negative. Four lesional skin biopsies and one lymph node biopsy were performed and sent for histopathology and culture. The skin biopsy showed small‐vessel lumen occlusion by tiny thrombi, endothelial hyperplasia, and intense perivascular inflammatory reaction throughout the dermis, together with partial degeneration of collagen, compatible with tuberculid. Lymph node biopsy showed chronic, necrotizing, granulomatous lymphadenitis, consistent with a diagnosis of lymph node tuberculosis. Mycobacteria were absent on Ziehl–Neelsen staining and culture in all specimens. 1 Varioliform atrophic scarring over the extensor surface of the arms, typical of papulonecrotic tuberculid (PNT) 2 Varioliform atrophic scarring over the back, typical of papulonecrotic tuberculid (PNT) On the basis of the clinical features, positive tuberculin skin test, and histopathologic findings, a diagnosis of papulonecrotic tuberculid associated with tuberculous lymphadenitis was made. A triple therapeutic regimen with rifampicin, isoniazid, and pyrazinamide was started and the patient evolved with progressive clinical improvement. At the end of treatment at 6 months, there was clinical remission and improvement of anemia and ESR. Four months later, however, there was a clinical relapse of the lesions on the scalp, ultimately resulting in cicatricial alopecia with varioliform atrophic scarring (Figs 3 and 4). A biopsy of these new lesions was performed and showed focal necrosis (V‐shaped) in the epidermis and dermis with follicular involvement and thrombotic occlusion of vessels, confirming the diagnosis of tuberculid. The patient was retreated with rifampicin, isoniazid, pyrazinamide, and ethambutol for 9 months. A new investigation of another internal focus of tuberculosis was negative. 3 Cicatricial alopecia with varioliform atrophic scarring appearing after 6 months of treatment for tuberculosis 4 Cicatricial alopecia with varioliform atrophic scarring appearing after 6 months of treatment for tuberculosis In the last 2 years, the patient has had several recurring crops of lesions on the scalp. Further biopsies were taken, with histopathology showing nonspecific inflammatory changes. Cultures for Mycobacterium spp. were negative (five media: Lowenstein–Jensen, Lowenstein–Jensen supplemented with ferric ammonium citrate or pyruv...

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“…9 To date, only one case of vulval tuberculid has been reported, which occurred in a 2year-old girl, but in the context of a more widespread papulonecrotic eruption. 10 In conclusion, we describe a rare case of localized papulonecrotic tuberculid of the vulva and to a lesser extent the perineum, secondary to TB lymphadenopathy and pulmonary TB. In retrospect, the episode of erythema nodosum 3 years before the patient's clinical presentation was most likely the initial feature of TB.…”

Section: Reportmentioning

confidence: 74%

An unusual case of vulval papulonecrotic tuberculid

Wong

Rizvi

Cerio

et al. 2010

Clinical and Experimental Dermatology

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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. Localized forms are rare, and mainly involve the genitalia in men. We describe a 26-year-old Indian woman with lymphatic and pulmonary tuberculosis (TB) in association with localized papulonecrotic tuberculid of the vulva, which resolved promptly on treating the underlying TB.

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Papulonecrotic Tuberculid in a 2‐Year‐Old Girl: With Emphasis on Extent of Disease and Presence of Leucocytoclastic Vasculitis

Abstract: The clinicopathologic features of childhood papular necrotic

Cited by 6 publications

References 13 publications

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Papulonecrotic tuberculid on the scalp

An unusual case of vulval papulonecrotic tuberculid

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