Successful diagnosis and management of tuberculosis verrucosa cutis using antituberculosis therapy trial approach

Abstract

Tuberculosis verrucosa cutis is a paucibacillary form of cutaneous tuberculosis that often occurs in sensitized immunocompetent individuals due to exogenous reinfection. The diagnosis is often difficult because the clinical features are often not typical and acid-fast staining test often shows negative results. Therapeutic trial with antituberculosis therapy is justified if there is strong clinical suspicion in which diagnosis can be made based on the therapeutic response. We report a 46-year-old male with erythematous verrucous plaque on the right knee and crusted erythematous plaque on the left dorsal foot that had been present for 20 years. There were neither history of previous trauma nor tuberculosis treatment. Histopathology, culture, polymerase chain reaction (PCR), Mantoux test, and chest radiograph were negative for cutaneous tuberculosis. Gamma release interferon assay showed positive result. The patient was given category 1 antituberculosis treatment and showed improvement after three weeks. Treatment was continued for 6 months and the lesion significantly regressed.

Chronic violaceous plaques on the arm

“…6 There is no reported sensitivity for QuantiFERON in cutaneous TB, though it has tested positive in other cases of TVC. 7,8 Treatment is with multidrug antituberculosis therapy, which was effective in our case. In clinically suspicious cases with negative PCR, significant improvement with empirical TB treatment can corroborate the diagnosis.…”

“…In clinically suspicious cases with negative PCR, significant improvement with empirical TB treatment can corroborate the diagnosis. 8 This case demonstrates a challenging case of cutaneous Mtb, requiring repeated tissue cultures to reach the diagnosis.…”

“…Treatment is with multidrug antituberculosis therapy, which was effective in our case. In clinically suspicious cases with negative PCR, significant improvement with empirical TB treatment can corroborate the diagnosis 8 …”

“…TB is an enzyme‐linked immunospot (ELISPOT) assay with a sensitivity of 91.6% for cutaneous TB 6 . There is no reported sensitivity for QuantiFERON in cutaneous TB, though it has tested positive in other cases of TVC 7,8 …”

Tuberculosis verrucosa cutis in a patient with pulmonary tuberculosis: A case report

“…Tuberculous verrucosa cutis occurs exogenously, which means M. tuberculosis directly enters through the micro wound or abrasion to create inoculation forming papules or nodes, usually solitary but also can be multiple, which further become hyperkeratotic, resembling warts (warty papule) on an erythematous base, without pain and systemic symptoms. [5][6][7]9,15,16 This disease is generally found in areas prone to trauma, such as extremities. 17 This disease often occurs in health workers, laboratory workers, farmers, butchers, and infected children through contact with contaminated soil.…”