Understanding cutaneous tuberculosis: two clinical cases

Maio, Flavio De; Trecarichi, Enrico Maria; Visconti, Elena; Sanguinetti, Maurizio; Delogu, Giovanni; Sali, Michela

doi:10.1099/jmmcr.0.005070

Cited by 10 publications

(8 citation statements)

References 40 publications

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“…Histologic diagnosis of CTB is based on pathologic findings of lymphocytes, epithelioid histiocytes, giant cells, necrosis, and granuloma. Histology assists in differentiating other skin pathologies that mimic TB [13, 15, 16]. Our patient’s skin histologic examination results are depicted in the figures and support the diagnosis of scrofuloderma.…”

Section: Discussionsupporting

confidence: 66%

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Scrofuloderma with disseminated tuberculosis in an Ethiopian child: a case report

Tadele

2018

J Med Case Reports

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BackgroundCutaneous tuberculosis represents only 1–2% of extrapulmonary forms of tuberculosis. Scrofuloderma is an endogenous form of cutaneous tuberculosis and can present as isolated or coexist with pulmonary and disseminated forms of tuberculosis. Pathologically confirmed scrofuloderma coexisting with disseminated tuberculosis with a good treatment response is presented and discussed.Case presentationA 12-year-old African Ethiopian girl presented with bilateral neck swelling with purulent discharge and skin ulceration of 3 months’ duration. Dry cough, low-grade fever, decreased appetite, drenching night sweats, global throbbing headache, and a significant amount of weight loss were also reported. Biopsy of the skin identified scrofuloderma, and Mycobacterium tuberculosis was also identified by Xpert MTB/RIF assay. Cerebrospinal fluid analysis and brain computed tomographic scans showed tuberculous meningitis and tuberculoma. Antituberculosis therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol; prednisolone; pyridoxine; and wound care were provided. The patient was discharged for outpatient directly observed antituberculosis therapy in a nearby health center after acute complications were treated and once the skin lesion had started to dry or heal.ConclusionsCutaneous tuberculosis should be considered in a child presenting with a skin lesion or discharge. Cutaneous tuberculosis cases should be investigated for coexisting pulmonary and extrapulmonary forms of tuberculosis. Histopathologic diagnosis should be considered to rule out other skin pathologies and also to prevent delay in treatment. Better tuberculosis prevention strategies, including vaccination scale-up, are warranted.

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Section: Discussionsupporting

confidence: 66%

“…This is a common problem in endemic TB settings such as Ethiopia. Even then, it is not a routine practice in Ethiopian settings to do a TST for TB screening, and hence it was not done in our patient [14, 15]. Extrapulmonary TB diagnosis, including CTB, using the Xpert MTB/RIF assay is recommended by the WHO [14].…”

Section: Discussionmentioning

confidence: 99%

Scrofuloderma with disseminated tuberculosis in an Ethiopian child: a case report

Tadele

2018

J Med Case Reports

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“…Additionally, of the cutaneous TB sites, the finger is seldom seen. It has been identified in only a small number of cases in adults [6][7][8]. There have been, however, more reports of TB tenosynovitis or dactylitis in the hands, with swellings and pain, rather than cutaneous lesions [9][10][11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Tuberculosis in the Finger

Mahdi¹,

Alabdan²,

Amer³

et al. 2021

Cureus

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“…Individuals exposed to malnutrition or unhygienic conditions, or suffering from diabetes mellitus, end-stage renal disease, malignancies, HIV co-infection, or through submission to immunosuppressive therapy, and infants and pregnant women, amongst others, are at risk of contracting active CTB [ 26 , 76 , 77 ]. Overall, a diverse collection of individuals is vulnerable, especially due to the global increase in MDR-TB and XDR-TB [ 78 ].…”

Section: Cutaneous Tuberculosis An Extra-pulmonary Infectionmentioning

confidence: 99%

“…This variety of clinical CTB manifestations severely complicates diagnoses. Moreover, CTB is an elusive dermal condition as it resembles a number of visually similar dermal disorders [ 32 , 63 , 76 , 79 ]. In addition, the microbial basis of CTB infection ( Figure 3 ) may be difficult to define, even though improved detection techniques including culture smears, polymerase chain reaction examinations and enzyme-linked-immunosorbent serologic assays are available [ 33 , 34 , 63 , 79 , 83 , 84 ].…”

Section: Cutaneous Tuberculosis An Extra-pulmonary Infectionmentioning

confidence: 99%

Adapting Clofazimine for Treatment of Cutaneous Tuberculosis by Using Self-Double-Emulsifying Drug Delivery Systems

2022

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Although chemotherapeutic treatment regimens are currently available, and considerable effort has been lavished on the development of new drugs for the treatment of tuberculosis (TB), the disease remains deeply intractable and widespread. This is due not only to the nature of the life cycle and extraordinarily disseminated habitat of the causative pathogen, principally Mycobacterium tuberculosis (Mtb), in humans and the multi-drug resistance of Mtb to current drugs, but especially also to the difficulty of enabling universal treatment of individuals, immunocompromised or otherwise, in widely differing socio-economic environments. For the purpose of globally eliminating TB by 2035, the World Health Organization (WHO) introduced the “End-TB” initiative by employing interventions focusing on high impact, integrated and patient-centered approaches, such as individualized therapy. However, the extraordinary shortfall in stipulated aims, for example in actual treatment and in TB preventative treatments during the period 2018–2022, latterly and greatly exacerbated by the COVID-19 pandemic, means that even greater pressure is now placed on enhancing our scientific understanding of the disease, repurposing or repositioning old drugs and developing new drugs as well as evolving innovative treatment methods. In the specific context of multidrug resistant Mtb, it is furthermore noted that the incidence of extra-pulmonary TB (EPTB) has significantly increased. This review focusses on the potential of utilizing self-double-emulsifying drug delivery systems (SDEDDSs) as topical drug delivery systems for the dermal route of administration to aid in treatment of cutaneous TB (CTB) and other mycobacterial infections as a prelude to evaluating related systems for more effective treatment of CTB and other mycobacterial infections at large. As a starting point, we consider here the possibility of adapting the highly lipophilic riminophenazine clofazimine, with its potential for treatment of multi-drug resistant TB, for this purpose. Additionally, recently reported synergism achieved by adding clofazimine to first-line TB regimens signifies the need to consider clofazimine. Thus, the biological effects and pharmacology of clofazimine are reviewed. The potential of plant-based oils acting as emulsifiers, skin penetration enhancers as well as these materials behaving as anti-microbial components for transporting the incorporated drug are also discussed.

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Understanding cutaneous tuberculosis: two clinical cases

Cited by 10 publications

References 40 publications

Scrofuloderma with disseminated tuberculosis in an Ethiopian child: a case report

Scrofuloderma with disseminated tuberculosis in an Ethiopian child: a case report

A Case Report of Tuberculosis in the Finger

Adapting Clofazimine for Treatment of Cutaneous Tuberculosis by Using Self-Double-Emulsifying Drug Delivery Systems

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