An Unusual Presentation of Cutaneous Tuberculosis for Surgeons—Review Of Literature

Abstract

Tuberculosis is one of the oldest diseases on earth. With rising trends of immunosuppressive states, the extrapulmonary manifestations of tuberculosis have emerged and are flourishing. Most often it is the systemic dissemination of the bacilli from the primary infective foci during the periods of low immunity. Cutaneous manifestation of tuberculosis in the form of injection abscess or traumatic inoculation is well known; however, sporadic occurrence of it in the form of abscess with no underlying lesions is quite rare. This would caution the treating units in the endemic areas about the possibility of tuberculosis as the disease in any inflammatory disorder of skin with acute presentations with no systemic symptoms. Only a high index of suspicion would render an early detection and recovery. Our case is one such incident.

Cutaneous tuberculosis overview and current treatment regimens

“…Such clinical presentations can vary from small papules, warty lesions, ulcers, or papules to highly deformative plaques that are thickened and hyperkeratotic [24,37,49,63,8,53,35]. It is very important to diagnose and treat TB as early as possible to avoid any complications, although it has often been misdiagnosed as tinea corporis and carcinoma, for example [2,70,41,59,65].…”

“…Exogenous inoculation can cause a warty lesion on the fingers, or other extremities, called tuberculosis verrucosa cutis (TVC), in patients previously infected with TB and who have moderate to high immunity [2,39,49,50]. TVC (also known as prosector's wart, lupus verricosus and warty tuberculosis) starts as a painful, small papule, surrounded by a purple, inflammatory corona that progresses into an asymptomatic warty lesion, as illustrated in Figure 2 [51,24,44,52,40,53].…”

“…A discharge then starts and eventually a cutaneous abscess forms. These abscesses may heal spontaneously, although it takes years to completely cure [2,36,54,37,49,53,35]. Scrofuloderma is the most common form of CTB among children younger than ten years of age, with a prevalence of 36e48% [41].…”

Nonoperative management of craniovertebral junction and cutaneous tuberculosis

“…[ 2 8 ] The three most prevalent types of cutaneous TB are scrofuloderma, lupus vulgaris, and TB verrucosa cutis. [ 2 8 15 18 ] Scrofuloderma is a multibacillary form of cutaneous TB. Lesions present as firm, red-brown nodules overlying a bone or joint.…”

Cutaneous and Skeletal Simultaneous Locations as a Rare Clinical Presentation of Tuberculosis

“…The prevalence of the pulmonary and extra-pulmonary tuberculosis has increased in the last decades, attributed to immunosuppression related to HIV and other diseases like cancer, Diabetes Mellitus, end-stage chronic renal disease, congenital immunodeficiency's, and the high use of immunosuppressant drugs [ 3 ]. The resurgence has been attributed to a combination of HIV and other factors as increasing inner city deprivation, the arrival of immigrants from countries with a high incidence of tuberculosis, and dismantling of surveillance and contact-tracing services.…”