Skin-nontumor - Tuberculosis

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Skin-nontumor

Infectious disorders

Tuberculosis

Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 11 July 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Cutaneous disease is uncommon in U.S

Epidemiology
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● Primary (inoculation) tuberculosis of the skin is the cutaneous analogue of the pulmonary ghon focus
● Primary cutaneous tuberculosis may be associated with tattooing, ritual circumcision, nose piercing, inoculation of homeopathic solutions or injury by contaminated objects to laboratory workers, surgeons or prosectors; there may be no obvious source of infection
● Erythema induratum of Bazin: also called nodular vasculitis if no coexisting tuberculosis; rare, more common in past; presents as recurrent tender subcutaneous nodules on calves of women with tuberculin hypersensitivity
● Lichen scrofulosorum: lichenoid eruption of minute papules in children and adolescents with tuberculosis (Indian J Dermatol Venereol Leprol 2010;76:494)
● Lupus vulgaris: most common form of re-infection tuberculosis, occurring predominantly in young adults; refers to painful cutaneous TB skin lesions with a nodular appearance, usually near the nose, eyelids, lips, cheeks and ears; untreated lesions may develop into disfiguring skin ulcers ("lupus" historically meant an ulcerative skin disorder), and are associated with squamous cell carcinoma
● Tuberculids: heterogeneous group of cutaneous lesions due to TB infection elsewhere in the body

Clinical description
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● Red indurated papule appears 1-3 weeks after penetrating injury; papule ulcerates and forms a so-called "tuberculoid chancer"

Case reports
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● Cases occuring after mesotherapy cosmetic treatment (Biomedica 2010;30:321)

Clinical images
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Various images

Post-mesotherapy (intradermal injections) lesions

Adult woman with erythrocyanotic circulation and ulcerated lesions

Micro description
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● Early lesions have a mixed dermal infiltrate of neutrophils, lymphocytes and plasma cells; followed by superficial necrosis and ulceration
● Weeks later, tuberculoid granulomas form, with variable caseation necrosis
● Acid-fast bacilli are usually easy to find in the early lesions, but are rare once granulomas develop
● Erythema induratum of Bazin: granulomatous vasculitis affecting subcutaneous large vessels (may need multiple serial sections to identify); also granulomatous inflammation of lobules of subcutis; lesions may contain acid-fast bacilli by PCR

Micro images
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Various images

Contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain

Positive stains
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● Acid-fast stains and PCR are positive

End of Skin-nontumor > Infectious disorders > Tuberculosis

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