Tuberculose sous cutanée cervico-thoracique: à propos d’un cas

Unusual cervicofacial localization of two subcutaneous tuberculous cold abscesses in an immunocompetent subject

“…Subcutaneous tuberculous cold abscesses are a rare and unusual form of tuberculosis accounting for 1% of the extra pulmonary form of the disease [ 4 ]. They are most commonly described in patients with severe and disseminated tuberculosis, especially during human immunodeficiency virus (HIV) infection [ [5] , [6] , [7] ]. Cervicofacial localization is exceptional and may be either isolated or associated with other forms of tuberculosis.…”

“…Inoculation may be direct by transcutaneous route of the tuberculosis agent, especially in agricultural environments. Hematogenous dissemination in the blood or lymphatic system is evoked for forms complicating miliary tuberculosis or associated with other extra-pulmonary or multifocal bone diseases, contiguous extension of a cervical tuberculous adenitis is the most predominant mechanism of cervical subcutaneous tuberculous abscesses [ 2 , 5 , 6 , 8 ]. Three risk factors have been identified as predisposing to extrapulmonary tuberculosis: black race, female gender and immunosuppression [ 7 ].…”

“…They are characterised by an insidious onset leading to a delay in diagnosis and are manifested by a soft swelling that rarely fluctuates, rarely suggesting an infectious origin, with fistulisation of the skin in the later forms. Tuberculous abscesses are often single, but may present with two or more sites [ 5 , 6 , 9 ]. Medical imaging is useful for diagnosis, although the radiological presentation of subcutaneous tuberculous cold abscesses is non-specific.…”

“…Ultrasound can be used to determine the echogenicity of a swelling seen on clinical examination. CT scan and magnetic resonance imaging (MRI) can be used to study the locoregional extension of the abscess and to search for other locations that are inaccessible on clinical examination [ 5 , 6 , 9 ]. In our case, the patient was known to have MPT + pulmonary tuberculosis in the second phase of her anti-tuberculosis treatment, the liquid nature of the two fronto-glabellar and cervical swellings was confirmed by cranio-cervicofacial CT scan which eliminated the presence of other deep anomalies.…”

“…Evidence of the germ on direct examination of the pus is rare, which explains the delay in treatment, hence the interest of the polymerase chain reaction (PCR) using the Xpert gene. The latter allows a rapid diagnosis and therefore the initiation of a standard anti-tuberculosis treatment that can be modified later according to the results of the cultures [ 5 , 6 , 10 ]. In our case, the diagnosis of abscess was made by puncturing the two collections, which yielded a purulent fluid.…”