Papulonecrotic tuberculids: a rare cutaneous manifestation of tuberculosis in pregnancy

Abstract

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. At 36 weeks gestation she re-presented with multiple skin lesions on her arms, legs and buttocks. Initial investigation found no obvious cause for her presentation. The decision for induction of labour was taken as the patient was not improving, and resulted in an uncomplicated Caesarean delivery. After delivery, Mantoux and Quantiferon tests were reported to be positive and the patient was diagnosed with papulonecrotic tuberculides.

Perspectives on tuberculosis in pregnancy

“…Reported outcomes are frequently better in high-income populations, 43,44 but many cases are diagnosed late, as the symptoms may be confused with those of other possible conditions; some cases may even be diagnosed retrospectively after identification of neonatal TB. 45,46 Reported presentations include, but are not restricted to, papulonecrotic tuberculids, 47 TB spine, 48,49 meningitis, 50 primitive caeco-appendicular TB, 51 genital TB as a possible cause of ectopic pregnancy, 52,53 pericarditis, 54 hemoptysis, 55,56 and peritoneal TB. [57][58][59] Foetal outcomes range from being completely asymptomatic, to serious congenital abnormalities, and even a spontaneous abortion with TB histology in both placenta and foetus.…”

Papulonecrotic tuberculides as a key to the diagnosis of tuberculosis: a case report

“…The initial diagnosis is clinical and should be confirmed with a skin biopsy. 3,4 It typically shows necrotizing granulomatous vasculitis with granulomatous foci containing giant cells. 4 The Ziehl-Neelsen stain and mycobacterial cultures are usually negative.…”