Background:Lichen scrofulosorum is considered a rare form of cutaneous tuberculosis. Current information is based on case reports and case series with a small number of patients. Methods:Thirty-nine patients with Lich...Background:Lichen scrofulosorum is considered a rare form of cutaneous tuberculosis. Current information is based on case reports and case series with a small number of patients. Methods:Thirty-nine patients with Lichen scrofulosorum were followed during the period January 1996 to December 2002. Clinical details(age,sex,durationofdisease,associatedtubercularlesions, extent and distribution of skin lesions), laboratory parameters (hemoglobin, total leucocytic counts, erythrocyte sedimentation rate, Mantoux test, presence of BCG scar), and response to antitubercular treatment were recorded and analyzed. Results:7.6%patients of all (511) patients with cutaneous tuberculosis had LS. 22 (56.4%) were males and 32 (84%) were below 15 years of age. Twenty-eight (72%) had an associated focus of tuberculosis elsewhere in the body; 13 (33%) had tubercular lymphadenopathy, while 11 (28%), three (8%) and six (15%)had pulmonary tuberculosis, intracranial tuberculosis and other forms of cutaneous tuberculosis, respectively. Six (15%) had tubercular focus at multiple sites. Eleven (28%) had no other identifiable focus of tuberculosis. Twenty-eight (72%) had evidence of receiving BCG vaccination. Trunk was the commonest (100%) affected site.The two groups with and without associated tubercular focus were not different with respect to age, sex, duration of disease, hemoglobin, total leukocyte count, erythrocyte sedimentation rate, Mantoux test positivity, and presence of BCG scar. Mycobacteria tuberculosis could not be detected either on acid fast bacilli (AFB) staining or on culture from biopsies of LS lesions. All patients (including those without evidence of tubercular focus) responded to antitubercular treatment, signifying an underlying occult tubercular focus as etiology. Conclusions:Lichen scrofulosorum is an uncommon but not rare cutaneous manifestation of tuberculosis. A high index of suspicion and awareness is required for diagnosis. Systemic tuberculosis is often associated with LS and a prior BCG inoculation does not protect against development of LS. Response to antitubercular treatment is good irrespective of the presence or absence of associated tubercular focus.展开更多
Tuberculids (papulonecrotic tuberculid, erythema induratum, and lichen scrofulosorum) are cutaneous hypersensitivity reactions to Mycobacterium tuberculosis. We report the fifth case of a recently described tuberculid...Tuberculids (papulonecrotic tuberculid, erythema induratum, and lichen scrofulosorum) are cutaneous hypersensitivity reactions to Mycobacterium tuberculosis. We report the fifth case of a recently described tuberculid, nodular tuberculid. The distinguishing feature was that of a granulomatous vasculitis occurring at the dermohypodermal junction on biopsy specimen of the subcutaneous nodules.展开更多
Aims and objectives. Resurgence of skin tuberculosis especially with drug-resistant strains has been well documented in recent years, but this problem has not received much attention in the paediatric age group. Hence...Aims and objectives. Resurgence of skin tuberculosis especially with drug-resistant strains has been well documented in recent years, but this problem has not received much attention in the paediatric age group. Hence, we carried out the present study to analyse the clinical and therapeutic aspects of cutaneous tuberculosis in children. Materials and methods. A detailed clinical examination, investigations, such as haemogram, serology for HIV, Mantoux test, chest X-ray, cytology, culture and histopathologywere carried out in all children. They were treated with antitubercular therapy (WHO regimen), and the clinical response was followed up. Results. Of 142 patients with cutaneous tuberculosis, 68 were children (40 females, 28 males). These children were aged from 9 months to 14 years. The duration of the disease varied from 1 month to 6 years. Family history of tuberculosis was present in 28 (41.2%) of the patients. Scrofulodermawas themost commonpresentation encountered in 30 (44.1%) patients with preferential involvement of the cervical (56.2%) and inguinal (20%) regions. Fifteen (22.1%) patients had lupus vulgaris, of which the keratotic type was the most common (46.7%), 16 had lichen scrofulosorum, three had tuberculosis verrucosa cutis, and four had more than one type of tuberculosis. Involvement of the lung in 14 (20.6%), bone in seven (10.2%), and both in four (5.9%) was found. Histopathology corroborated the clinical diagnosis in 54 (80.6%), culture was positive in six (8.8%). Fifty (73.5%)-patients completed the treatment with an excellent response, no multi-drug resistant cases were seen. Conclusions. Cutaneous tuberculosis in children continues to be an important cause of morbidity, there is a high likelihood of internal involvement, especially in patients with scrofuloderma. A search is required for more sensitive, economic diagnostic tools. Response to treatment at 4 weeks often helps in substantiating the diagnosis of tuberculosis in doubtful cases.展开更多
文摘Background:Lichen scrofulosorum is considered a rare form of cutaneous tuberculosis. Current information is based on case reports and case series with a small number of patients. Methods:Thirty-nine patients with Lichen scrofulosorum were followed during the period January 1996 to December 2002. Clinical details(age,sex,durationofdisease,associatedtubercularlesions, extent and distribution of skin lesions), laboratory parameters (hemoglobin, total leucocytic counts, erythrocyte sedimentation rate, Mantoux test, presence of BCG scar), and response to antitubercular treatment were recorded and analyzed. Results:7.6%patients of all (511) patients with cutaneous tuberculosis had LS. 22 (56.4%) were males and 32 (84%) were below 15 years of age. Twenty-eight (72%) had an associated focus of tuberculosis elsewhere in the body; 13 (33%) had tubercular lymphadenopathy, while 11 (28%), three (8%) and six (15%)had pulmonary tuberculosis, intracranial tuberculosis and other forms of cutaneous tuberculosis, respectively. Six (15%) had tubercular focus at multiple sites. Eleven (28%) had no other identifiable focus of tuberculosis. Twenty-eight (72%) had evidence of receiving BCG vaccination. Trunk was the commonest (100%) affected site.The two groups with and without associated tubercular focus were not different with respect to age, sex, duration of disease, hemoglobin, total leukocyte count, erythrocyte sedimentation rate, Mantoux test positivity, and presence of BCG scar. Mycobacteria tuberculosis could not be detected either on acid fast bacilli (AFB) staining or on culture from biopsies of LS lesions. All patients (including those without evidence of tubercular focus) responded to antitubercular treatment, signifying an underlying occult tubercular focus as etiology. Conclusions:Lichen scrofulosorum is an uncommon but not rare cutaneous manifestation of tuberculosis. A high index of suspicion and awareness is required for diagnosis. Systemic tuberculosis is often associated with LS and a prior BCG inoculation does not protect against development of LS. Response to antitubercular treatment is good irrespective of the presence or absence of associated tubercular focus.
文摘Tuberculids (papulonecrotic tuberculid, erythema induratum, and lichen scrofulosorum) are cutaneous hypersensitivity reactions to Mycobacterium tuberculosis. We report the fifth case of a recently described tuberculid, nodular tuberculid. The distinguishing feature was that of a granulomatous vasculitis occurring at the dermohypodermal junction on biopsy specimen of the subcutaneous nodules.
文摘Aims and objectives. Resurgence of skin tuberculosis especially with drug-resistant strains has been well documented in recent years, but this problem has not received much attention in the paediatric age group. Hence, we carried out the present study to analyse the clinical and therapeutic aspects of cutaneous tuberculosis in children. Materials and methods. A detailed clinical examination, investigations, such as haemogram, serology for HIV, Mantoux test, chest X-ray, cytology, culture and histopathologywere carried out in all children. They were treated with antitubercular therapy (WHO regimen), and the clinical response was followed up. Results. Of 142 patients with cutaneous tuberculosis, 68 were children (40 females, 28 males). These children were aged from 9 months to 14 years. The duration of the disease varied from 1 month to 6 years. Family history of tuberculosis was present in 28 (41.2%) of the patients. Scrofulodermawas themost commonpresentation encountered in 30 (44.1%) patients with preferential involvement of the cervical (56.2%) and inguinal (20%) regions. Fifteen (22.1%) patients had lupus vulgaris, of which the keratotic type was the most common (46.7%), 16 had lichen scrofulosorum, three had tuberculosis verrucosa cutis, and four had more than one type of tuberculosis. Involvement of the lung in 14 (20.6%), bone in seven (10.2%), and both in four (5.9%) was found. Histopathology corroborated the clinical diagnosis in 54 (80.6%), culture was positive in six (8.8%). Fifty (73.5%)-patients completed the treatment with an excellent response, no multi-drug resistant cases were seen. Conclusions. Cutaneous tuberculosis in children continues to be an important cause of morbidity, there is a high likelihood of internal involvement, especially in patients with scrofuloderma. A search is required for more sensitive, economic diagnostic tools. Response to treatment at 4 weeks often helps in substantiating the diagnosis of tuberculosis in doubtful cases.
