Clinicoepidemiological characteristics of cutaneous tuberculosis in 1458 Indian patients: a retrospective analytical study from a tertiary care center

Abstract

Background Tuberculosis (TB) has been one of the most challenging infectious diseases globally. Cutaneous tuberculosis (CTB) accounts for 0.5-2% of extrapulmonary TB and is often missed owing to its varying morphology and paucibacillary nature. Methods In this retrospective analytical study, we share our 22-year experience to describe the clinicoepidemiological features and treatment response of CTB in 1458 Indian patients. In each patient, detailed history was followed by clinical examination, hematological and biochemical investigations, Mantoux testing, chest x-ray, and other specialized investigations to detect coexisting systemic foci. Clinical diagnosis of CTB was confirmed on histopathology/cytology and response to standard antitubercular treatment (ATT). All details were recorded on a predesigned proforma. ResultsOf 1458 eligible patients, 803 were children. The mean disease duration was 15.3 months. Lupus vulgaris (40.4%) was the most common clinical variant, followed by scrofuloderma (32.7%) and lichen scrofulosorum (15.2%). Other variants included tuberculosis verrucosa cutis, gumma, tuberculids, and inoculation TB. Multiple clinical variants were observed in 3.6% of patients. A total of 41.4% of patients had coexistent systemic foci; in lymph nodes (50.4%), lungs (35.6%), bone (10.3%), and abdomen (5.8%). TB foci were also observed at uncommon locations like the eye, central nervous system, and genital organs. Treatment response to ATT was favorable in 99.2%.Interpretation The burden of CTB still persists in developing countries. The diagnosis is often missed due to the wide spectrum of clinical and histological presentations.Awareness among clinicians of varying aspects of CTB is of paramount importance for early diagnosis and management and will significantly prevent morbidity and disease complications.

Co‐existence of atypical tuberculid with lupus vulgaris

“…PCR on skin biopsy samples was not performed due to some technical reasons. In pediatric settings, there have been a few reports of LV co‐occurring with tuberculids; none had the presentation, described here 1,6,10,11 . In our patient, skin biopsy from hypopigmented lesions showed changes consistent with tuberculid reminiscent of LS.…”

“…Mycobacterial tuberculosis (TB) remains a significant challenge, disproportionately affecting developing countries and underserved communities. Cutaneous TB (CTB) is rare, accounting for a 0.5%–2% of extra‐pulmonary TB 1 . The prevalence of CTB among children in different studies has been reported to range from 19% to 55% 1–5 .…”

“…Cutaneous TB (CTB) is rare, accounting for a 0.5%–2% of extra‐pulmonary TB 1 . The prevalence of CTB among children in different studies has been reported to range from 19% to 55% 1–5 . Lupus vulgaris (LV), a slowly progressive form of paucibacillary CTB in patients with moderate immunity, accounts for 21% to 63% of the pediatric CTB cases 1–5 .…”

“…[4][5][6]9 Tuberculids, commonly described in association with tuberculosis of lymph nodes, lungs, and other organ systems, are rarely reported with CTB. 1,9,10 We report a rare case with an atypical presentation of tuberculid with hypopigmented, scaly maculopapular lesions in association with lupus vulgaris.…”

“…1 The prevalence of CTB among children in different studies has been reported to range from 19% to 55%. [1][2][3][4][5] Lupus vulgaris (LV), a slowly progressive form of paucibacillary CTB in patients with moderate immunity, accounts for 21% to 63% of the pediatric CTB cases. [1][2][3][4][5] The lesions manifest as slowly progressive, erythematous to brownish papules, nodules, and plaques with active periphery and central atrophy and scarring.…”