download full issue - Our Dermatology Online Journal

More documents

Recommendations

Info

Case Report GIANT TUBERCULOSIS VERRUCOSA CUTIS OLBRZYMIA BRODAWKUJĄCA GRUŹLICA SKÓRY Rokon Uddin 1 , Farzana Akhter 2 , Abu Baker 1 1 Department of skin & VD, Enam Medical College & Hospital, Savar, Dhaka, Bangladesh 2 Department of skin & VD Upozila Health Complex, Savar, Dhaka, Bangladesh Corresponding author: Dr. Md. Rokon Uddin drrokon47@gmail.com Our Dermatol Online. 2012; 3(1): 21-23 Date of submission: 04.08.2011 / acceptance: 19.10.2011 Conflicts of interest: None Abstract A 38year old man had asymptomatic slowly progressive warty lesion on extensor surface of left elbow and arm for about 20 years. Examination revealed larger one sized of 16cm×15cm and smaller one about 8cm×5cm. Lesions were Keratotic, verrucous, nontender, cauliflower-like indurated plaque. Mantoux test resulted 20mm×18mm on 48 hours observation. Histopathological examination of the lesion showed epitheloid cell granuloma with giant cells and lymphocytes in the mid dermis. The conclusive diagnosis was tuberculosis verrucosa cutis based on above findings. Six month therapy with INH 300mg plus Rifampicin 600mg supplemented initial 2 months ethambulol 1000mg plus pyrazinamide 1500mg daily resulted complete clearance of the lesions. Streszczenie 38-letnia kobieta zgłosiła się z asymptomatyczną, powoli powiększającą się brodawkowatą zmianą na powierzchni wyprostnej lewego łokcia i ramienia, obecną od 20 lat. Badanie fizykalne wykazało dwie zmiany: większą o wym. 16x15cm i mniejszą o wym. 8x5cm. Zmiany miały postać keratotycznych, brodawkowatych, niebolesnych, kalafiorowatego kształtu blaszek. Test Mantoux po 48 godzinach wyniósł 20x18mm. Badanie histopatologiczne ujawniło ziarniniaki komórkowe w naskórku wraz z komórkami olbrzymimi oraz limfocytami w warstwie środkowej skóry. Na podstawie w/w badań postawiono diagnozę gruźlicy brodawkującej skóry. WdroŜono 6- miesięczną terapię 300mg INH z 600mg rifampicyną, wspomaganą przez pierwsze 2 miesiące: 1000mg etambutolu i 1500mg pirazynamidu, które zaskutkowały całkowitym ustąpieniem zmian skórnych. Key words: skin tuberculosis; tuberculosis verrucosa cutis; gaint Słowa klucze: skórna postać gruźlicy; tuberculosis verrucosa cutis; olbrzymi Introduction Tuberculosis is quite common in Bangladesh. Tuberculosis verrucosa cutis (TVC) occurs from exogenous inoculation of bacilli into the skin of a previously sensitized person with strong immunity against Mycobacterium tuberculosis [1].The tuberculin test is strongly positive. Clinically, the lesion begins as a small papule, which becomes hyperkeratotic, resembling a wart. The lesion enlarges by peripheral expansion, with or without central clearing, sometimes reaching several centimeters or more in diameter [1]. Lesions are almost always solitary, and regional adenopathy is usually present only if secondary bacterial infection occurs. The infection is exogenously acquired and hence the lesions usually appear on exposed or trauma prone areas [2]. A case of accidental infection through throne pricks leading to the lesions which spared gradually for the last 20 years, larger one almost cover the left extensor elbow. Case report A 38 years old man presented with history of asymptomatic, gradually progressing, warty growth, on the back of left elbow and arm for 20 years. The lesions were preceded by thorn pricks. There were no constitutional or systemic symptoms. He did not have any past or family history of tuberculosis. Cutaneous examination revealed keratotic, nontender, cauliflower like indurated plague ranging from 16cm ×15cm to 8cm× 5cm on the back of left elbow and on back of the left arm (Fig. 1,2). There was no lymphadenopathy. Systemic examination was unremarkable. Histopathological examination of the lesion showed pseudoepitheliomatous hyperplasia of the epidermis and a epitheloid cell granuloma having giants cells and lymphocytes in the mid dermis (Fig. 3). Ziehl- Neelson staing of the tissue did not reveal any acid fast bacilli. Mantoux test was positive (20mm×18mm on 2 nd day). © Our Dermatol Online 1.2012 21
Hematological investigations revealed a normal haemogram except ESR which was marked as 40mm in 1 st hour (Westergren method). Other routine investigations of the blood, urine and stool were unremarkable. Skiagram of the chest showed no abnormality. Figure 1. Hyperkeratotic plaque arising at the site of inoculation in an individual Figure 2. Hyperkeratotic cauliflower like indurated plaque left extensor elbow Figure 3. Focus under Zeiss Microscope with Epitheloid cell granuloma having giants cells and lymphocytes in the mid dermis 10 magnificsation Based on these clinical features, histopathology and Montoux test, a diagnosis of tuberculosis verrucosa cuits was confirmed. The patient was treated with six month therapy INH 300mg plus Rifampicin 600mg supplemented with initial 2 months ethambulol 1000mg plus pyrazinamide 1500mg daily resulted complete clearence of the lesion. Six months later the histopathological examination of the tissue was done and the result found unremarkable. Conclusion TVC patients usually have moderate or high degree of immunity. This patient had positive Mantoux test to support these criteria. The sites which are commonly involved are exposed parts of the body such as fingers, hands, wrists, forearm, arm, ankles, feet, knees, heels and in case of children buttocks [3]. This patient’s lesion was also over the extensor elbow & back of arm- which support the criteria. The man acquired the infection through thorn pricks. Usually TVC begins as small papule and become hyperkeratotic enlarges by peripheral expansion and sometimes reaching several centimeters. This case had cauliflower like lesion about 16cm ×15cm which was quite larger than usual. Complete clearance of warty lesions after the treatment with the anti tubercular regimen composed of INH, Rifampicin, Ethambulol, and Pyrazinamide was strongly suggestive of tubercular etiology. 22 © Our Dermatol Online 1.2012
Page 1 and 2: Volume 3, Number 1, January 2012 IS
Page 3 and 4: Editorial Board: Al Aboud Khalid, M
Page 5 and 6: ► Anca Chiriac, Anca E Chiriac, A
Page 7 and 8: in patients without HIV [6]. Studie
Page 9 and 10: 8. Opstelten W, Mauritz JW, de Wit
Page 11 and 12: Original Articles DERMATITIS DE INT
Page 13 and 14: Vacuolar Liquenoide Superficial Sup
Page 15 and 16: Figura 7. Caso clínico 2. Clínica
Page 17 and 18: 7. Bastuji-Garin S, Rzany B, Stern
Page 19 and 20: Case report A 45 year old lady was
Page 21: eaction primarily involving multipl
Page 25 and 26: Case Report FACIAL PLEXIFORM NEUROF
Page 27 and 28: Recklinghausen’s disease. It acco
Page 29 and 30: Comments to the article FACIAL PLEX
Page 31 and 32: osteo-articular pain or any other a
Page 33 and 34: miliary cutaneous osteomas [10]. Th
Page 35 and 36: Figure 3. Eight months after surgic
Page 37 and 38: Case Report IMMUNOFLUORESCENCE IN M
Page 39 and 40: Figure 1. a through c, clinical pic
Page 41 and 42: Figure 3. a. IIF utilizing veal bra
Page 43 and 44: 18. Vera-Recabarren MA, García-Car
Page 45 and 46: Physical examination revealed a 6 c
Page 47 and 48: Case Report TUMOR CUTÁNEO DE CÉLU
Page 49 and 50: Figura 2. Caso 1. Histopatología.
Page 51 and 52: Caso Edad Sexo Localización Delimi
Page 53 and 54: Case Report SEBORRHEIC DERMATITIS E
Page 55 and 56: Comments to the article SEBORRHEIC
Page 57 and 58: OS is also known as Reticuloendothe
Page 59 and 60: Figure 3-8. Dorsal ungual pterygium
Page 61 and 62: Figure 12,13. Dorsal ungual pterygi
Page 63 and 64: intake was more prevalent among wom
Page 65 and 66: Dermatology Eponyms SEPARATING ''BA
Page 67 and 68: Dermatology Eponyms DERMATOLOGY EPO
Page 69 and 70: Figure 5. Filatov sign Figure 3. Fi
Page 71 and 72: szpitalu St Thomas. Dr Greenhow zos
Page 73 and 74:
FORSCHHEIMER SIGN Small, red spots
Page 75 and 76:
EDWARD FRANCIS American microbiolog
Page 77 and 78:
zawierających olejek bergamotki, e
Page 79:
8. Daher EF, Silva GB Jún, Lima RS
show all

download full issue - Our Dermatology Online Journal

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?