Pulmonary Tuberculosis Presenting with Cutaneous Leukocytoclastic Vasculitis

Abstract

This case report deals with a rare association: tuberculosis and cutaneous leukocytoclastic vasculitis. The patient was a 36-year-old man with no significant past medical problems. He presented with a palpable purpura on both legs, low-grade fever, cough and expectoration, progressive dyspnea due to a massive left pleural effusion and a symmetric swelling on his ankles and wrists. Skin biopsy yielded a histological diagnosis of leukocytoclastic vasculitis and the primary diagnosis was only achieved after performing a pleural biopsy, which unequivocally showed the presence of Mycobacterium tuberculosis. This case shares many features with the few cases already reported in the medical literature. Possible pathogenic mechanisms are reviewed and discussed in detail.

Tuberculosis should not be ignored in patients with peripheral gangrene

“…The mechanism of injury proposed for vasculitis is deposition of immune complexes in the vascular wall rather than direct aggression of M. tuberculosis. 11 The existence of circulating immune complexes has been demonstrated in 56% of patients with active TB, and that their levels are related to disease activity. 12 To our knowledge, TB had no association with medium-vessel vasculitis.…”

Henoch-Schoenlein Purpura Associated with Pulmonary Mycobacterium avium-intracellulare Complex

“…Hypersensitivity vasculitis, where the microorganism has never been found and the proposed pathogenic mechanism is the deposit (in the walls of small vessels) of immune complexes formed by antibodies to M. tuberculosis proteins (8). Henoch-Schönlein purpura is thought to be an immune complex disease, with 50% of patients producing IgA rheumatoid factor (9).…”

Tuberculous cerebrovascular disease: A review

“…93,94 Despite this, tuberculous vasculopathy remote from an inflammatory exudate or from mycobacterial antigen would appear to be rare, although cutaneous leukocytoclastic vasculitis in patients with intrathoracic TB has been reported. 95 One reported example of apparently isolated ''tuberculous carotid and coronary arteritis'' 96 would appear more likely to represent idiopathic giant cell arteritis. Although potentially immune-mediated, TBM vasculitis appears to be restricted largely to infected/ inflamed tissues, and in this sense therefore is not a typical multi-system immune vasculitis.…”