+ Translate
+ Most Popular
The pigeon tick (Argas reflexus): its biology, ecology, and epidemiological aspects
Prevalence of hemoglobin abnormalities in Kebili (Tunisian South)
Lipogranuloma: a preventable complication of dacryocystorhinostomy
Value of basal plasma cortisol assays in the assessment of pituitary-adrenal insufficiency
Bees from the Belgian Congo. The acraensis group of Anthophora
Placing gingival retraction cord
Total serum IgE, allergy skin testing, and the radioallergosorbent test for the diagnosis of allergy in asthmatic children
Acariens plumicoles Analgesoidea parasites des oiseaux du Maroc
Injuries of terminal phalanges of the fingers in children
Biology of flowering and nectar production in pear (Pyrus communis)
Das Reliktvorkommen der Aspisviper (Vipera aspis L.) im Schwarzwald
Hydrological modelling of drained blanket peatland
Pathologic morphology and clinical significance of the anomalous origin of the left circumflex coronary artery from the right coronary artery. General review and autopsy analysis of 30 cases
Cyto genetic analyses of lymphocyte cultures after exposure to calcium cyclamate
Axelrodia riesei, a new characoid fish from Upper Rio Meta in Colombia With remarks concerning the genus Axelrodia and description of a similar, sympatric, Hyphessobrycon-species
Favorable evolution of a case of tuberculosis of pancreas under antibiotic action
RIFM fragrance ingredient safety assessment, Valencene, CAS Registry Number 4630-07-3
Parenteral microemulsions: an overview
Temperate pasture: management for grazing and conservation
Evaluation of a new coprocessed compound based on lactose and maize starch for tablet formulation
Thermal expansion and cracking of three confined water-saturated igneous rocks to 800C
Revision of the genera of the tribe Stigmoderini (Coleoptera: Buprestidae) a discussion of phylogenetic relationships
Anal tuberculosis. Report of a case
Gastric tuberculosis in the past and present
Adaptive responses of the cardiovascular system to prolonged spaceflight conditions: assessment with Holter monitoring

Latent-disseminated tuberculosis revealed by atypical skin ulcerations

Latent-disseminated tuberculosis revealed by atypical skin ulcerations

Annales de Dermatologie et de Venereologie 143(10): 616-621

ISSN/ISBN: 0151-9638

PMID: 27342431

DOI: 10.1016/j.annder.2016.05.003

Cutaneous tuberculosis (CT) is rare in industrialized countries. Given the clinicopathological polymorphism and the difficulty of isolating the pathogen, diagnosis can be difficult. The condition may be associated with other known locations of the disease or in rare cases, it may be a tell-tale sign, as in our case, in which leg ulcers revealed paucisymptomatic disseminated tuberculosis. A 67-year-old man was referred for rapidly extensive ulcers of the right leg contiguous to debilitating arthritis of the knee of unknown aetiology for 18 months. Earlier investigations revealed thymoma and a pulmonary nodule considered to be sarcoidosis. A skin biopsy showed a granulomatous eosinophilic-rich infiltrate and vasculitis of the small vessels. Screening of the skin sample and gastric aspirate for Koch Bacillus (BK) was negative. A diagnosis of sarcoidosis was made. A positive QuantiFERON test eventually led to the correct diagnosis. On further testing of bronchoalveolar fluid and a synovial biopsy, culture for Mycobacterium tuberculosis (MT) was positive. The PET scan showed high metabolism in the prostate, bone, spleen, liver, nodes and heart. The quad- and then dual-antibiotic antitubercular therapies produced a rapid improvement but treatment was continued over 12 months, given the persistence of high metabolism on PET-CT scan and the low blood rifampicin concentration. A CT should be considered in the presence of giant-cell granulomas, even in the absence of caseous necrosis, and where both direct examination and culture for the skin are negative. Our case also underlines the importance of an extensive workup to rule out disseminated disease even if the patient is not symptomatic.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 058202335

Download citation: RISBibTeXText

Related references

Disseminated skin ulcerations associated with chronic renal failure. Der Hautarzt; Zeitschrift für Dermatologie Venerologie und verwandte Gebiete 58(6): 538-540, 2007

Development of Disseminated Tuberculosis with Intestinal Involvement due to Adalimumab Administration Despite Latent Tuberculosis Treatment. Internal Medicine 59(6): 849-853, 2020

Multidrug-resistant Disseminated Tuberculosis Related to Infliximab in a Patient with Ulcerative Colitis and Negative Evaluation for Latent Tuberculosis. Korean Journal of Gastroenterology 74(3): 168-174, 2019

Disseminated cutaneous tuberculosis: an atypical presentation of reinfection (secondary) tuberculosis in an immunocompetent individual. American Journal of Dermatopathology 35(7): E128-E130, 2013

Latent and atypical tuberculosis. France Medecine 12(2): 3-5, 1949

Association of the level of IFN-γ produced by T cells in response to Mycobacterium tuberculosis-specific antigens with the size of skin test indurations among individuals with latent tuberculosis in a highly tuberculosis-endemic setting. International Immunology 24(2): 71-78, 2012

Evaluation of a new interferon gamma release assay, in comparison to tuberculin skin tests and quantiferon tuberculosis goldplus for the detection of latent tuberculosis infection in children from a high tuberculosis burden setting. International Journal of Mycobacteriology 10(2): 142-148, 2021

Inconspicuous consumption: disseminated tuberculosis following untreated latent infection. Journal of Paediatrics and Child Health 40(4): 227-229, 2004

Atypical presentation of disseminated tuberculosis--a case report. Journal of the Singapore Paediatric Society 28(3-4): 254-256, 1986

Atypical disseminated skeletal tuberculosis mimicking metastasis on PET-CT and MRI. Internal Medicine 51(20): 2961-2965, 2012

Atypical Cerebral Manifestations of Disseminated Mycobacterium tuberculosis. Frontiers in Neurology 8: 462, 2017

Atypical presentation of immunoglobulin A vasculitis in disseminated tuberculosis. International Journal of Dermatology 58(1): E1-E3, 2019

First isolation of Vibrio tapetis and an atypical strain of Aeromonas salmonicida from skin ulcerations in common dab (Limanda limanda) in the North Sea. Journal of Fish Diseases 41(2): 329-335, 2018

Atypical pulmonary tuberculosis indicative of latent pneumoconiosis. Archives des Maladies Professionnelles de Medecine du Travail et de Securite Sociale 15(5): 393-398, 1954

A Rare Culprit of Spontaneous Abortion, Latent Tuberculosis Complicated by Disseminated Peritoneal TB. Case Reports in Infectious Diseases 2018: 2318539, 2018