Cutaneous tuberculosis in Rio de Janeiro, Brazil: description of a series of 75 cases

Abstract

Background Brazil is one of the highest tuberculosis (TB) burden countries of the world. Cutaneous tuberculosis (CTB) is a rare form of extrapulmonary manifestation of tuberculosis. This study aimed to describe the clinico‐evolutive, laboratory and therapeutic aspects of CTB cases among patients from a cohort with TB in Rio de Janeiro, Brazil. Methods Cases of diagnosed CTB with microbiologic confirmation or clinical response to anti‐tuberculous treatment associated with positive smear or histopathological findings between the years 2000 and 2016 were selected. Results Seventy‐five patients with CTB were included, most were women (58.7%) with a median age of 42 years. CTB diagnosis was based on culture in only 42.7% of the cases. Scrofuloderma represented 50.7% of the cases, followed by erythema induratum of Bazin (EIB) (18.7%), tuberculous gumma (13.3%), lupus vulgaris (8%), TB verrucosa cutis (4%), orificial TB (2.7%) and associated forms (2.7%). Other TB presentations were pulmonary (22.7%), mammary (6.6%) and osteoarticular (4%). All patients who completed the treatment (97.3%) had their lesions healed. Only two patients (2.6%) needed to change the therapy due to adverse reactions. Fifty percent of EIB patients presented recurrence. Conclusions These data highlight the diversity of CTB presentations and the importance of the skin to assist in early identification and treatment of TB. More studies are necessary to improve the knowledge on EIB for a better approach towards these patients, mainly in cases of recurrence.

Lupus Vulgaris: A Diagnostic Challenge

“…1,6 In Europe, the predominant form of cutaneous tuberculosis is lupus vulgaris, which may represent 61.1% of the cases, 7 whereas scrofuloderma is the most common presentation in some developing countries such as Brazil. 5 According to the WHO, Brazil is one of the twenty countries in the ranking with the highest incidence of tuberculosis, 8 and 40% of patients over 45 years of age with typical cutaneous lesions may have coexistent pulmonary tuberculosis, 9 which was not apparently the case of this patient.…”

“…Cutaneous manifestations of tuberculosis are classified into true cutaneous tuberculosis or tuberculids. 5 Cutaneous tuberculosis includes a continuous spectrum according to the degree of immunity and the route of infection. Some authors further define the infection according to the amount of bacilli found in skin lesions as paucibacillary or multibacillary, the latter being associated with more deficient degrees of immunity.…”

“…3 Although considered the most common subtype of cutaneous tuberculosis in studies conducted in Spain, China, Indian, Japan and Pakistan, it is known that lupus vulgaris is underestimated and its diagnosis can be neglected. 4,5 We present an immunocompetent patient with lupus vulgaris whose clinical and histopathological features were challenging in establishing the diagnosis.…”

Estudo da incidência e da resposta terapêutica da tuberculose cutânea em hospital de referência do Distrito Federal

“…33 Além disso, no presente estudo foi identificado um predomínio de aproximadamente 66% no sexo masculino, diferentemente do descrito na maioria dos estudos sobre TBC. 33,34,35,36,37,38 Azevedo e Oliveira (2016), por exemplo, analisaram 26 pacientes com diagnóstico de TBC, sendo 18 mulheres e 8 homens (30%). 39 Porém, percebese que na Espanha, Índia, China, Hong Kong e Mali, o sexo masculino apresenta maiores taxas de incidência desta doença.…”

“…48 A faixa etária em que se encontraram mais casos de TBC foi entre 41-60 anos, com mediana de 53 anos, sendo essa um pouco mais tardia do que o observado na literatura, que evidencia resultados entre 35 e 48 anos. 33,34,36,38,39,41,50 No estudo de Zhang et al (2018) mais de 77,6% dos pacientes analisados com diagnóstico de TBC estavam na faixa etária entre 10 e 49 anos, com a maior incidência (61,9%) entre 10 e 39 anos. 19 No presente estudo, somente 41,6% dos pacientes estavam entre a faixa etária de 10-49 anos.…”