Unusual Cutaneous Manifestations of Miliary Tuberculosis

Abstract

Cutaneous manifestations of miliary tuberculosis are extremely rare. We describe a 62-year-old woman with leukopenia who developed infiltrated dermal-hypodermal and ulcerative cutaneous lesions during the course of miliary tuberculosis. Miliary tuberculosis was diagnosed when Mycobacterium tuberculosis bacilli were isolated by cultures of the bronchoalveolar lavage fluid and blood and when acid-fast bacilli were detected on histopathologic examination of hepatic, pulmonary, and cutaneous biopsy specimens. With the increasing incidence of immunocompromised patients, unusual presentations of tuberculosis may be observed more often. Acute miliary tuberculosis of the skin is an exceptional manifestation that is due to acute hematogenous dissemination of M. tuberculosis to the skin. We describe a patient who had unusual cutaneous manifestations of miliary tuberculosis.

Tuberculous Cellulitis in a Patient with Chronic Kidney Disease and Polymyalgia Rheumatica

“…We diagnosed the skin lesion as tuberculous cellulitis, not tuberculid, because tuberculous bacilli were found in the lesion, a phenomenon that does not usually occur in tuberculid. Cellulitis caused by tuberculosis has rarely been reported, and many of the reported cases were showed to be skin lesions in patients with miliary tuberculosis (7)(8)(9). The infectious route in our patient was thought to be hematogenous dissemination from the lungs based on the clinical findings and the patient's past history.…”

“…Erythema induratum, papulonecrotic tuberculid and lichen scrofulosorum are included in this type. Cellulitis caused by tuberculosis has rarely been reported (5, 6); however, many of cases have been shown to occur as skin manifestations of miliary tuberculosis (7)(8)(9).…”

Cutaneous miliary tuberculosis in two patients with hiv infection

“…6 It has also been described in a handful of patients with immune dysfunction secondary to malignancy, chemotherapy, or immunosuppression status post organ transplant or for treatment of autoimmune disease. [7][8][9][10] In fact, a review of the literature from 1889 to 1991 yields only 18 biopsy or culture-proven cases reported in patients older than 15 years. [7][8][9][10][11] Cutaneous miliary tuberculosis in the setting of HIV infection was first reported by Stack, Bickley, and Coppel 12 in 1990.…”

“…[7][8][9][10] In fact, a review of the literature from 1889 to 1991 yields only 18 biopsy or culture-proven cases reported in patients older than 15 years. [7][8][9][10][11] Cutaneous miliary tuberculosis in the setting of HIV infection was first reported by Stack, Bickley, and Coppel 12 in 1990. Since that time, 16 additional cases of disseminated miliary tuberculosis have been described in patients coinfected with HIV, including the two reported herein (Table I).…”

“…7,[11][12][13][14][15][16][17][18][19][20][21][22] Histological features include an acute inflammatory infiltrate composed exclusively of neutrophils, focal superficial dermal necrosis, and without true caseating granulomas (Table I). 7,8,22 Cutaneous miliary tuberculosis in HIV patients has often been a harbinger of rapid clinical progression and frequent patient demise. Pulmonary infection is the likely source of the disseminated mycobacteria in the majority of the cases (Table I).…”