Tuberculosis should not be ignored in patients with peripheral gangrene

Yao, Yuan; Liu, Bin; Wang, Jibo; Li, Hua; Liang, Hong

doi:10.1016/j.jvs.2010.07.017

Cited by 7 publications

(10 citation statements)

References 13 publications

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“…HIV-induced endothelial dysfunction, vascular wall injury, increased viral load and associated increase in inflammatory cytokines and tumour necrosis factor-α have been proposed [59,60]. Leucocytoclastic and granulomatous vasculitis, manifestations of type III and type IV hypersensitivity reactions [62], respectively, were present in 12 and 1 biopsy each, respectively, in the present study. Mycobacteria were identified in 5 biopsies within vessels that displayed leucocytoclastic vasculitis.…”

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

confidence: 60%

“…Leucocytoclastic vasculitis may be caused by a range of viral, fungal, bacterial and parasitic diseases. While M.Tb and HIV may cause vascular pathology independently by several mechanisms, the presence of vasculitis in the context of TB and HIV co-infection is poorly reported [54][55][56][57][58][59][60][61][62]. The co-occurrence of TB and vasculitis was first reported in 1967 [55].…”

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

confidence: 99%

See 1 more Smart Citation

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: 60%

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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“…Association of tuberculosis has also been noted with small vessel vasculitis, like leukoclastic vasculitis. To our knowledge, there has been only one case of medium vessel vasculitis caused by tuberculosis (7) . The patient had vasculitis of the left posterior tibial artery and peroneal artery secondary to tuberculosis infection.…”

Section: Discussionmentioning

confidence: 99%

Digital Gangrene in Disseminated Tuberculosis: A Rare Presentation

Bansal¹,

Tyagi²

2017

IOSR JDMS

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“…In the present case, the etiology was found to be spinal TB and her gangrene resulted in secondary to TB. Some case reports have described gangrene secondary to TB due to vasculitis [7]. Vasculitis is a clinicopathologic process characterized by blood vessel wall inflammation, which can be primary or secondary to other systemic diseases.…”

Section: Discussionmentioning

confidence: 99%

“…TB has also been associated with small vessel vasculitis, such as leukocytoclastic vasculitis. However, there is only one report of medium vessel vasculitis caused by TB [7].…”

Section: Discussionmentioning

confidence: 99%

Digital gangrene in spinal tuberculosis

Hussain

Sharma

Synmon

et al. 2020

IJCR

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Though tuberculosis (TB) is commonly seen, peripheral gangrene as a manifestation of TB is not common. Spinal TB presents with backache, paraparesis, or quadriparesis with or without bladder and bowel involvement. It may cause spinal deformities. However, peripheral gangrene is not a common manifestation of spinal TB. Here, we present the case of spinal TB, with peripheral gangrene in a 30-year-old female. There was blackening and shrinkage of the left third toe, with superficial tenderness, darkening, and loss of sensation over the left fourth and fifth toes. Tuberculin test and Mantoux test were positive. The magnetic resonance imaging findings were suggestive of Pott's spine. Arterial Doppler of the affected lower limb revealed sluggish flow, as suggested by the biphasic waveform. The patient was started on antituberculous treatment. Although the neurological symptoms improved with antituberculous treatment, the peripheral gangrene resolved only partially and required amputation.

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Tuberculosis should not be ignored in patients with peripheral gangrene

Cited by 7 publications

References 13 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

Digital Gangrene in Disseminated Tuberculosis: A Rare Presentation

Digital gangrene in spinal tuberculosis

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