<b>Nodular granulomatous phlebitis of the skin: a fourth type of tuberculid</b>

Hara, Kazuo; Tsuzuki, Toyonori; Takagi, Norio; Shimokata, Kaoru

doi:10.1046/j.1365-2559.1997.d01-575.x

Cited by 39 publications

(25 citation statements)

References 12 publications

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“…This was congruent with the concept of tuberculids that, by definition, lack mycobacteria on histopathological appraisal and microbiological culture [34,51]. Tuberculids are cutaneous hypersensitivity tuberculous reactions in patients with visceral TB, and include papulonecrotic tuberculid, lichen scrofulosorum, erythema induratum, nodular granulomatous phlebitis and nodular tuberculid [31,33,34,52]. Heightened recognition of vulval papulonecrotic tuberculid, a tuberculous granulomatous, ulcerative lesion with a zoned inflammatory pattern ( Figure 5E) that lacks acid fast bacilli, is therefore necessary to avoid misdiagnosis of other infective, ulcerative granulomatous lesions, including syphilis, schistosomiasis and lymphogranuloma venereum [34].…”

Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (supporting

confidence: 58%

“…Vasculitis is also a defining feature of selected tuberculids, viz. papulonecrotic tuberculid, erythema induratum, nodular tuberculid and nodular granulomatous phlebitis [34,52] that are associated with visceral TB. In the present study, the visceral tuberculous source for immune complex generation in the pathogenesis of the leucocytoclastic vasculitis in the papulonecrotic tuberculid was tuboovarian TB (Table 1).…”

Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (mentioning

confidence: 99%

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Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Gb¹,

Ramdial²,

Nargan³

et al. 2017

J AIDS Clin Res

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Objective: Vulval tuberculosis (TB) is reported rarely. The histomorphological spectrum and diagnostic mimicry thereof in patients with concomitant HIV infection/ AIDS is unreported to date. This study aimed to appraise the histopathologic spectrum of vulval TB in HIV co-infected patients and to identify histopathological diagnostic challenges, mimicry and pitfalls.Methods: Ten year retrospective study that reappraised the histomorphological features of vulval TB in HIV-infected patients. Results:The clinical descriptions of the biopsied lesions from 19 patients that form the study cohort encompassed nodules (9), ulcers (5), hypertrophy/edema (3) and abscesses (2). The main microscopic features included necrotizing and non-necrotizing granulomatous inflammation, ulceration with a zoned inflammatory response and chronic suppurative inflammation. The necrotizing component had the typical morphology of caseative necrosis or of suppuration/karyorrhexis or an admixture of both necrosis types. Vasculitis, of varied histomorphology, was present in 15 biopsies. Infective special stains were pivotal diagnostic tools. The presence of mycobacteria on Ziehl Neelsen stains (ZNs) and absence of nonmycobacterial infective agents on additional infective stains, underpinned TB diagnosis, especially in biopsies that lacked prototypical granulomatous inflammation or of infective mimickers that manifest with a granulomatous phenotype. ZNs also confirmed mycobacteria in vasculitic foci. The absence of mycobacteria on ZNs facilitated the diagnosis of tuberculids. Conclusion:Lesions with a common clinical appearance had heterogeneous histomorphological features, while lesions with common histopathological features demonstrated divergent clinical morphology. Infective, especially Ziehl Neelsen, stains are pivotal in the histopathological work-up of infective/inflammatory vulval biopsies. It is possible that the rarely reported anergic mononuclear or abscessing features, pseudotumoral spindle cell reactions, ulcers with a zoned inflammatory response and the presence of vasculitis of varied type, are clues to the HIV-TB tissue partnership. Increased clinicopathological investigation of and reporting on vulval TB in the HIV/AIDS afflicted population is pivotal to ascertain this.

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Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (supporting

confidence: 58%

Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (mentioning

confidence: 99%

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Gb¹,

Ramdial²,

Nargan³

et al. 2017

J AIDS Clin Res

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“…2 Histopathologic differential diagnosis of our case includes the so-called nodular granulomatous phlebitis. 10 This entity is now considered a fourth type of tuberculid, because the lesions develop in patients with hypersensivity to purified protein derivate, but without active tuberculosis. Cutaneous lesions of this fourth type of tuberculid usually consist of nodular lesions on the lower limbs.…”

Section: Discussionmentioning

confidence: 99%

Superficial Thrombophlebitis: A New Clinical Manifestation of the Immune Reconstitution Inflammatory Syndrome in a Patient With HIV Infection

Alcaraz¹,

Revelles²,

Camacho³

et al. 2010

The American Journal of Dermatopathology

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Skin manifestations of immune reconstitution inflammatory syndrome in response to highly active antiretroviral therapy may account for up to 50% of the clinical presentations in this syndrome. Viable or dying infective antigens, host antigens, tumoral antigens, and others may target immune reconstitution inflammatory syndrome, resulting in a wide spectrum of clinical manifestations. We describe a 26-year-old HIV-infected man who had started highly active antiretroviral therapy a few months earlier. He developed multiple linear nodules following the superficial veins in both legs. Histopathologic examination demonstrated a mostly septal panniculitis with features of superficial thrombophlebitis. We propose that superficial thrombophlebitis should be added to the list of clinical manifestations of this newly observed immune restoration disease.

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“…reviewed 20 cases of hepatic granulomas. It is also well known that some epithelioid granulomas are etiologically related to bacterial infection 18–22 . The etiology of hepatic granulomas amongst their cases was variable, though the patients with tuberculosis and idiopathic causes formed the major group.…”

Section: Discussionmentioning

confidence: 99%

Granulomatous phlebitis of small hepatic vein

Saito

Harada

Nakanuma

2002

J of Gastro and Hepatol

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Several cases of granulomatous phlebitis of small hepatic veins are reported in the literature, though the etiology remains unclear. We experienced a similar case of granulomatous phlebitis involving terminal hepatic venules and this case will be reported in comparison with two previous cases presenting in our laboratory. A 39-year-old-female had a long course of medical treatment for epilepsy. She suffered from acute liver injury after prolonged fever for more than 1 week. Leukocytosis (11,100/ micro L) without eosinophilia, and inflammatory reactions such as C-reactive protein (21.0 mg/dL) were pointed out. She suffered from transient disseminated intravascular coagulation, but these abnormalities recovered with antibiotic and steroid therapy. Liver biopsy revealed granulomatous lesions mainly involving terminal hepatic venules. The possibility of tuberculosis was excluded by a negative Thiel-Nielsen stain and a negative molecular study for bacterial deoxyribonucleic acid of Mycobacteria species. Extrahepatic involvements were not clear clinically. This case and the previous two cases shared granulomatous phlebitis of the intrahepatic small hepatic veins, as well as clinical features suggestive of bacterial infection. Clinicians should be aware of such a rare clinicopathological entity.

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Nodular granulomatous phlebitis of the skin: a fourth type of tuberculid

Cited by 39 publications

References 12 publications

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Superficial Thrombophlebitis: A New Clinical Manifestation of the Immune Reconstitution Inflammatory Syndrome in a Patient With HIV Infection

Granulomatous phlebitis of small hepatic vein

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