Tuberculous gummas: Epidemiological, clinical, bacteriological, immunological, and therapeutic features

Abstract

Tuberculous gummas are an unusual form of tuberculosis (TB) accounting for 1%-2% of all cutaneous TB cases. The aim of this article was to describe the epidemiological, clinical, bacteriological, immunological, and therapeutic features of this form upon a case report and a literature review. Forty-eight case reports were identified through a PubMed and Google Scholar search using the following keywords: "tuberculous gumma" and "metastatic tuberculous abscesse." Tuberculous gumma can occur at any age. Immunodepression is not a sine qua non condition to the development of the disease. Limbs are the most frequent site for gummas. Tuberculous gummas are associated to another location in only 73% of cases. The most frequent associated locations are lung, nodes, and musculoskeletal apparatus. Mantoux test is negative in 38% of cases. Skin stain is positive in 45% of cases and culture in 85% of cases. Giant epithelioid cell granuloma is present in 82.4% of cases. There is no universally accepted chemotherapy regimen for metastatic tuberculous abscesses. The classic 2RHZE/4RH is highly effective.

Metastatic tuberculous abscess: A rare manifestation of cutaneous tuberculosis

“…Trunk is also a common site. Presence of abundant fat in these sites may be responsible for this [7] . In the case of our patient, the skin lesions were very much similar to the description in the literature except for increased local temperature that can be explained by secondary bacterial infection.…”

Estudo da incidência e da resposta terapêutica da tuberculose cutânea em hospital de referência do Distrito Federal

“…Acomete mais frequentemente os membros, especialmente coxa e nádegas, geralmente sem comprometimento dos tecidos profundos. 26,27 A fistulização é tardia e, mesmo havendo atraso no diagnóstico, apenas 31% dos pacientes apresentam ulceração. 26 Por fim, há as tuberculides, que são condições cutâneas que surgem como reação imunológica à disseminação hematogênica dos bacilos de Mycobacterium tuberculosis, presentes em um local extra-cutâneo.…”

“…26,27 A fistulização é tardia e, mesmo havendo atraso no diagnóstico, apenas 31% dos pacientes apresentam ulceração. 26 Por fim, há as tuberculides, que são condições cutâneas que surgem como reação imunológica à disseminação hematogênica dos bacilos de Mycobacterium tuberculosis, presentes em um local extra-cutâneo. Podem ser agudas ou crônicas, pontuadas por crises agudas, com tendência à involução espontânea.…”

An evolving presentation of cutaneous tuberculosis

“…TB infections [2,3]. These morphologies include tuberculous chancre, TVC, LV, scrofuloderma, and metastatic tuberculous abscess [4].…”

“…Cutaneous tuberculosis (CTB) is an uncommon manifestation of tuberculosis (TB). Although TB is becoming increasingly common in the United States with 9,029 cases reported in 2017, CTB is reported in 1-2% of infections [1][2][3]. CTB has many different morphologies including tuberculous chancre, tuberculosis verrucosa cutis (TVC), lupus vulgaris (LV), scrofuloderma, and metastatic tuberculous abscess [4].…”