1887
No metrics data to plot.
The attempt to load metrics for this article has failed.
The attempt to plot a graph for these metrics has failed.

Cutaneous Tuberculosis

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.
Buy this Microbiology Spectrum Article
Price Non-Member $15.00
  • Authors: Michael K. Hill1, Charles V. Sanders2
  • Editor: David Schlossberg3
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Saint Tammany Parish Hospital, Covington, LA 70433; 2: Department of Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112; 3: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0010-2016
  • Received 27 September 2016 Accepted 07 December 2016 Published 24 February 2017
  • Michael K. Hill, eclee@stph.org
image of Cutaneous Tuberculosis
    Preview this microbiology spectrum article:
    Zoom in
    Zoomout

    Cutaneous Tuberculosis, Page 1 of 2

    | /docserver/preview/fulltext/microbiolspec/5/1/TNMI7-0010-2016-1.gif /docserver/preview/fulltext/microbiolspec/5/1/TNMI7-0010-2016-2.gif
  • Abstract:

    Cutaneous tuberculosis (TB) may present in various clinical manifestations. Skin involvement may occur as a result of exogenous inoculation, contiguous spread from a nearby focus of infection, or by hematogenous spread from a distant focus. Because the clinical presentation of cutaneous TB can vary widely, it is important to have a high index of suspicion in appropriate clinical settings. In this chapter, the various clinical manifestations of clinical TB are classified by source of infection (exogenous, endogenous, and hematogenous spread). These are linked to the clinical appearance and histology of the skin lesions. Hopefully, this will resolve the confusion created by the myriad of terms previously used in the medical literature. Once a diagnosis of cutaneous TB is entertained, a biopsy for both culture and histopathology should be submitted. In some cases histopathology may show nonspecific inflammation without classic granuloma formation. In these cases, monoclonal antibodies and polymerase chain reaction (PCR) testing may be useful. In fact, in recent years, PCR amplification has proven to be invaluable in assisting identification of from skin biopsies in patients with negative TB cultures. In most instances, treatment of cutaneous TB requires combination chemotherapy. This is especially important in patients with extra cutaneous disease, multiple skin lesions, and those with profound immunosuppression. Surgery also may play both a diagnostic and therapeutic role.

  • Citation: Hill M, Sanders C. 2017. Cutaneous Tuberculosis. Microbiol Spectrum 5(1):TNMI7-0010-2016. doi:10.1128/microbiolspec.TNMI7-0010-2016.

Key Concept Ranking

Enzyme-Linked Immunosorbent Assay
0.52272725
0.52272725

References

1. Baselga E, Barnadas MA, Margall N, de Moragas JM. 1996. Detection of M. tuberculosis complex DNA in a lesion resembling sarcoidosis. Clin Exp Dermatol 21:235–238. [PubMed]
2. Beyt BE, Jr, Ortbals DW, Santa Cruz DJ, Kobayashi GS, Eisen AZ, Medoff G. 1981. Cutaneous mycobacteriosis: analysis of 34 cases with a new classification of the disease. Medicine (Baltimore) 60:95–109.
3. Lenzini L, Rottoli P, Rottoli L. 1977. The spectrum of human tuberculosis. Clin Exp Immunol 27:230–237. [PubMed]
4. Dinning WJ, Marston S. 1985. Cutaneous and ocular tuberculosis: a review. J R Soc Med 78:576–581. [PubMed]
5. Sehgal VN, Wagh SA. 1990. Cutaneous tuberculosis. Current concepts. Int J Dermatol 29:237–252. [PubMed]
6. Sehgal VN, Jani MK, Srivastavia G. 1989. Changing patterns of cutaneous tuberculosis. Int J Dermatol 28:231–236. [PubMed]
7. Shengold MA, Sheingold H, Heights J. 1951. Oral tuberculosis. Oral Surg Oral Med Oral Pathol 4:239–250. [PubMed]
8. Angus BJ, Yates M, Conlon C, Byren I. 2001. Cutaneous tuberculosis of the penis and sexual transmission of tuberculosis confirmed by molecular typing. Clin Infect Dis 33:E132–E134. [PubMed]
9. Bjornstad R. 1947. Tubercular primary infection of genitalia: two case reports of venereal genital tuberculosis. Acta Derm Venereol 27:106.
10. Engelman WR, Putney FJ. 1972. Tuberculosis of the tongue. Trans Am Acad Ophthalmol Otolaryngol 76:1384–1386. [PubMed]
11. Goette DK, Jacobson KW, Doty DR. 1978. Primary cutaneous inoculation tuberculosis of the skin. Arch Dermatol 114:567–569. [PubMed]
12. Heilmaa KM, Muschenheim C. 1978. Primary cutaneous tuberculosis of the skin. Arch Dermatol 273:1035–1036.
13. Heycock JB, Noble TC. 1961. Four cases of syringe-transmitted tuberculosis. Tubercle 42:25–27. [PubMed]
14. Hole LE. 1913. Tuberculosis acquired through ritual circumcision. JAMA 61:99–102.
15. Hoyt EM. 1981. Primary inoculation tuberculosis. Report of a case. JAMA 245:1556–1557. [PubMed]
16. Kramer F, Sasse SA, Simms JC, Leedom JM. 1993. Primary cutaneous tuberculosis after a needlestick injury from a patient with AIDS and undiagnosed tuberculosis. Ann Intern Med 119:594–595. [PubMed]
17. Minkowitz S, Brandt LJ, Rapp Y, Radlauer CB. 1969. “Prosector’s wart” (cutaneous tuberculosis) in a medical student. Am J Clin Pathol 51:260–263. [PubMed]
18. Montgomery H. 1937. Histopathology of various types of cutaneous tuberculosis. Arch Dermatol Syph 35:698–715.
19. O’Donnell TF, Jr, Jurgenson PF, Weyerich NF. 1971. An occupational hazard—tuberculous paronychia. Report of a case. Arch Surg 103:757–758. [PubMed]
20. Pereira CA, Webber B, Orson JM. 1976. Primary tuberculous complex of the skin. JAMA 235:942. [PubMed]
21. Rytel MW, Davis ES, Prebil KJ. 1970. Primary cutaneous inoculation tuberculosis. Report of two cases. Am Rev Respir Dis 102:264–267. [PubMed]
22. Sahn SA, Pierson DJ. 1974. Primary cutaneous inoculation drug-resistant tuberculosis. Am J Med 57:676–678. [PubMed]
23. Strand S. 1946. Tubercular primary lesion on penis—cancer, penis venereal tuberculosis. Acta Derm Venereol 26:461.
24. Weaver RA. 1976. Tuberculosis of the tongue. JAMA 235:2418. [PubMed]
25. Michelson HE. 1924. Scrofuloderma gummosa (tuberculosis colliquativa). Arch Dermatol 10:565–578.
26. Lipper S, Watkins DL, Kahn LB, Stenn K. 1980. Nongranulomatous septic vasculitis due to miliary tuberculosis. A pitfall in diagnosis for the pathologist. Am J Dermatopathol 2:71–74. [PubMed]
27. Schmitt CL, Pomeranz JR, Pomeranz JR. 1976. Lupus vulgaris: recovery of living tubercle bacilli 35 years after onset. Cutis 18:221–223. [PubMed]
28. McAndrew PG, Adekeye EO, Ajdukiewicz AB. 1976. Miliary tuberculosis presenting with multifocal oral lesions. BMJ 1:1320. [PubMed]
29. Nepomuceno OR, O’Grady JF, Eisenberg SW, Bacon HE. 1971. Tuberculosis of the anal canal: report of a case. Dis Colon Rectum 14:313–316. [PubMed]
30. Barbagallo J, Tager P, Ingleton R, Hirsch RJ, Weinberg JM. 2002. Cutaneous tuberculosis: diagnosis and treatment. Am J Clin Dermatol 3:319–328. [PubMed]
31. Caplan SE, Kauffman CL. 1996. Primary inoculation tuberculosis after immunotherapy for malignant melanoma with BCG vaccine. J Am Acad Dermatol 35:783–785.
32. Izumi AK, Matsunaga J. 1982. BCG vaccine-induced lupus vulgaris. Arch Dermatol 118:171–172. [PubMed]
33. Lee SM, Hann SK, Chun SI, Lee SH, Park YK. 1994. An unusual form of skin tuberculosis following B.C.G. vaccination. J Dermatol 21:106–110. [PubMed]
34. Maguire A. 1968. Lupus marinus: the discovery, diagnosis and treatment of seventeen cases of lupus marinus. Br J Dermatol 80:213–219. [PubMed]
35. Bateman DE, Makepeace W, Lesna M. 1980. Miliary tuberculosis in association with chronic cutaneous tuberculosis. Br J Dermatol 103:557–560. [PubMed]
36. Fine RM, Meltzer HD. 1970. Psoriasiform lupus vulgaris: a case report. Int J Dermatol 9:273–277. [PubMed]
37. Fisher JR. 1977. Miliary tuberculosis with unusual cutaneous manifestations. JAMA 238:241–242. [PubMed]
38. Warin AP, Jones EW. 1977. Cutaneous tuberculosis of the nose with unusual clinical and histological features leading to a delay in the diagnosis. Clin Exp Dermatol 2:235–242.
39. Duncan WC. 1968. Cutaneous mycobacterial infections. Tex Med 64:66–70. [PubMed]
40. Martin AR, Mark EJ. 1972. Case 43-1972—granulomatous disease in a man from Honduras. N Engl J Med 287:872–878. [PubMed]
41. Stevens CS, Vander Ploeg DE. 1981. Lupus vulgaris: a case that escaped diagnosis for twenty-eight years. Cutis 27:510–511, 514–515, 525. [PubMed]
42. Förström L. 1969. Carcinomatous changes in lupus vulgaris. Ann Clin Res 1:213–219. [PubMed]
43. Harrison PV, Marks JM. 1980. Lupus vulgaris and cutaneous lymphoma. Clin Exp Dermatol 5:73–77. [PubMed]
44. Ljubenovic MS, Ljubenovic DB, Binic II, Jankovic AS, Jancic SA. 2011. Cutaneous tuberculosis and squamous-cell carcinoma. An Bras Dermatol 86:541–544. [PubMed]
45. Nyfors A. 1968. Lupus vulgaris, isoniazid, and cancer. The frequency of cancer deaths in 245 isoniazid-treated lupus vulgaris patients with an average observation period of 12 years. Scand J Respir Dis 49:264–269. [PubMed]
46. Zawirska A, Adamski Z, Stawicka E, Schwartz RA. 2009. Cutaneous squamous cell carcinoma developing in lupus vulgaris exfoliativus persistent for 40 years. Int J Dermatol 48:125–127. [PubMed]
47. Schein PS, Vickers HR. 1972. Lupus vulgaris and Hodgkin’s disease. Arch Dermatol 105:244–246. [PubMed]
48. Sehgal VN, Srivastava G, Khurana VK, Sharma VK, Bhalla P, Beohar PC. 1987. An appraisal of epidemiologic, clinical, bacteriologic, histopathologic, and immunologic parameters in cutaneous tuberculosis. Int J Dermatol 26:521–526. [PubMed]
49. Platou RV, Lennox RH. 1956. Tuberculous cutaneous complexes in children. Am Rev Tuberc 74:160–169; discussion, 169–172. [PubMed]
50. Yamauchi T, Klein JD, Farrell WF. 1973. Tuberculosis of the skin. Am J Dis Child 125:855–856. [PubMed]
51. Sundt A. 1925. A case of lupus dissematus (post exanthematic miliary tuberculosis cutis). Br J Dermatol 37:316–324.
52. McCray MK, Esterly NB. 1981. Cutaneous eruptions in congenital tuberculosis. Arch Dermatol 117:460–464. [PubMed]
53. Kennedy C, Knowles GK. 1975. Miliary tuberculosis presenting with skin lesions. BMJ 3:356. [PubMed]
54. Munt PW. 1972. Miliary tuberculosis in the chemotherapy era: with a clinical review in 69 American adults. Medicine (Baltimore) 51:139–155. [PubMed]
55. Reitbrock RC, Dahlmans RPM, Smedts F, Frantzen PJ, Koopman RJ, VanderMeer JW. 1991. Tuberculosis cutis miliaris dissemination as a manifestation of miliary tuberculosis. A literature review and report of a case of recurrent skin lesions. Rev Infect Dis 12:265–269.
56. Shaw NM, Basu AK. 1970. Unusual cold abscesses. Br J Surg 57:418–422. [PubMed]
57. Ward AS. 1971. Superficial abscess formation: an unusual presenting feature of tuberculosis. Br J Surg 58:540–543. [PubMed]
58. Daikos GL, Uttamchandani RB, Tuda C, Fischl MA, Miller N, Cleary T, Saldana MJ. 1998. Disseminated miliary tuberculosis of the skin in patients with AIDS: report of four cases. Clin Infect Dis 27:205–208. [PubMed]
59. Handwerger S, Mildvan D, Senie R, McKinley FW. 1987. Tuberculosis and the acquired immunodeficiency syndrome at a New York City hospital: 1978–1985. Chest 91:176–180. [PubMed]
60. Sunderam G, Mongura BT, Lombardo JM, Reichman LB. 1987. Failure of four-drug short course tuberculosis chemotherapy in a compliant patient with human immunodeficiency syndrome (AIDS). Am Rev Respir Dis 136:1475–1478. [PubMed]
61. Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB. 1986. Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS). JAMA 256:362–366. [PubMed]
62. Antinori S, Galimberti L, Tadini GL, Ridolfo AL, Parravicini C, Esposito R, Moroni M. 1995. Tuberculosis cutis miliaris disseminata due to multidrug-resistant Mycobacterium tuberculosis in AIDS patients. Eur J Clin Microbiol Infect Dis 14:911–914. [PubMed]
63. Corbett EL, Crossley I, De Cock KM, Miller RF. 1995. Disseminated cutaneous Mycobacterium tuberculosis infection in a patient with AIDS. Genitourin Med 71:308–310.
64. Libraty DH, Byrd TF. 1996. Cutaneous miliary tuberculosis in the AIDS era: case report and review. Clin Infect Dis 23:706–710. [PubMed]
65. Cohen C. 1977. Tuberculous mastitis. A review of 34 cases. S Afr Med J 52:12–14. [PubMed]
66. De Sousa R, Patil R. 2011. Breast tuberculosis or granulomatous mastitis: a diagnostic dilemma. Ann Trop Med Public Health 4:122–125.
67. Mukerjee P, Cohen RV, Niden AH. 1971. Tuberculosis of the breast. Am Rev Respir Dis 104:661–667. [PubMed]
68. Schaefer G. 1955. Tuberculosis of the breast; a review with the additional presentation of ten cases. Am Rev Tuberc 72:810–824. [PubMed]
69. Koch ML, Cote RA. 1965. Comparison of fluorescence microscopy with Ziehl-Neelsen stain for demonstration of acid-fast bacilli in smear preparations and tissue sections. Am Rev Respir Dis 91:283–284. [PubMed]
70. Wilner G, Nassar SA, Siket A, Azar HA. 1969. Fluorescent staining for mycobacteria in sarcoid and tuberculous granulomas. Am J Clin Pathol 51:584–590. [PubMed]
71. Benjamin RG, Daniel TM. 1982. Serodiagnosis of tuberculosis using the enzyme-linked immunoabsorbent assay (ELISA) of antibody to Mycobacterium tuberculosis antigen 5. Am Rev Respir Dis 126:1013–1016. [PubMed]
72. Daniel TM, Benjamin RG, Debanne SM, Ma Y, Balestrino EA. 1985. ELISA of IgG antibody to M. tuberculosis antigen 5 for serodiagnosis of tuberculosis. Indian J Pediatr 52:349–355. [PubMed]
73. Lai CC, Tan CK, Lin SH, Liu WL, Liao CH, Huang YT, Hsueh PR. 2011. Diagnostic value of an enzyme-linked immunospot assay for interferon-γ in cutaneous tuberculosis. Diagn Microbiol Infect Dis 70:60–64. [PubMed]
74. Nassau E, Parsons ER, Johnson GD. 1976. The detection of antibodies to Mycobacterium tuberculosis by microplate enzyme-linked immunosorbent assay (ELISA). Tubercle 57:67–70. [PubMed]
75. Senturk N, Sahin S, Kocagoz T. 2002. Polymerase chain reaction in cutaneous tuberculosis: is it a reliable diagnostic method in paraffin-embedded tissues? Int J Dermatol 41:863–866. [PubMed]
76. Tan SH, Tan BH, Goh CL, Tan KC, Tan MF, Ng WC, Tan WC, Tan WC. 1999. Detection of Mycobacterium tuberculosis DNA using polymerase chain reaction in cutaneous tuberculosis and tuberculids. Int J Dermatol 38:122–127. [PubMed]
77. Hsiao PF, Tzen CY, Chen HC, Su HY. 2003. Polymerase chain reaction based detection of Mycobacterium tuberculosis in tissues showing granulomatous inflammation without demonstrable acid-fast bacilli. Int J Dermatol 42:281–286. [PubMed]
78. Margall N, Baselga E, Coll P, Barnadas MA, de Moragas JM, Prats G. 1996. Detection of Mycobacterium tuberculosis complex DNA by the polymerase chain reaction for rapid diagnosis of cutaneous tuberculosis. Br J Dermatol 135:231–236. [PubMed]
79. Pai M. 2004. The accuracy and reliability of nucleic acid amplification tests in the diagnosis of tuberculosis. Natl Med J India 17:233–236. [PubMed]
80. Quirós E, Maroto MC, Bettinardi A, González I, Piédrola G. 1996. Diagnosis of cutaneous tuberculosis in biopsy specimens by PCR and southern blotting. J Clin Pathol 49:889–891. [PubMed]
81. Brück C, Westbeck-Carlsson M. 1964. Treatment of lupus vulgaris with INH exclusively. Acta Derm Venereol 44:223–225. [PubMed]
82. Förström L. 1969. Isoniazid treatment of lupus vulgaris. A long-term follow-up study. Ann Clin Res 1:36–39. [PubMed]
83. Ghanbar MI, Bukharie HA. 2015. Another hazard to laboratory workers. Saudi J Med Med Sci 3:174.
84. Kapoor S, Gandhi S, Gandhi N, Singh I. 2014. Oral manifestations of tuberculosis. CHRISMED J Health Res 1:11–14.
85. Küçükünal A, Ekmekçi TR, Sakız D. 2012. “Turkey ear” as a cutaneous manifestation of tuberculosis. Indian J Dermatol 57:504. [PubMed]
86. De Luca M. 1951. Skin tuberculosis. I. Etiology, pathogenesis, histology, classification. Rass Int Clin Ter 31:335–340. [PubMed]
87. Fisher I, Orkin M. 1966. Primary tuberculosis of the skin. Primary complex. JAMA 195:314–316. [PubMed]
microbiolspec.TNMI7-0010-2016.citations
cm/5/1
content/journal/microbiolspec/10.1128/microbiolspec.TNMI7-0010-2016
Loading

Citations loading...

Loading

Article metrics loading...

/content/journal/microbiolspec/10.1128/microbiolspec.TNMI7-0010-2016
2017-02-24
2017-09-19

Abstract:

Cutaneous tuberculosis (TB) may present in various clinical manifestations. Skin involvement may occur as a result of exogenous inoculation, contiguous spread from a nearby focus of infection, or by hematogenous spread from a distant focus. Because the clinical presentation of cutaneous TB can vary widely, it is important to have a high index of suspicion in appropriate clinical settings. In this chapter, the various clinical manifestations of clinical TB are classified by source of infection (exogenous, endogenous, and hematogenous spread). These are linked to the clinical appearance and histology of the skin lesions. Hopefully, this will resolve the confusion created by the myriad of terms previously used in the medical literature. Once a diagnosis of cutaneous TB is entertained, a biopsy for both culture and histopathology should be submitted. In some cases histopathology may show nonspecific inflammation without classic granuloma formation. In these cases, monoclonal antibodies and polymerase chain reaction (PCR) testing may be useful. In fact, in recent years, PCR amplification has proven to be invaluable in assisting identification of from skin biopsies in patients with negative TB cultures. In most instances, treatment of cutaneous TB requires combination chemotherapy. This is especially important in patients with extra cutaneous disease, multiple skin lesions, and those with profound immunosuppression. Surgery also may play both a diagnostic and therapeutic role.

Highlighted Text: Show | Hide
Loading full text...

Full text loading...

Figures

Image of FIGURE 1
FIGURE 1

Cutaneous TB from needlestick injury in a lab technologist. Reprinted with permission from reference 83 .

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0010-2016
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 2
FIGURE 2

Draining ulcer overlying tuberculous lymphadenitis—“scrofuloderma.” Photo courtesy of David Schlossberg.

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0010-2016
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 3
FIGURE 3

Tuberculous ulcer of tongue in patient with pulmonary tuberculosis. Reprinted with permission from reference 84 .

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0010-2016
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 4
FIGURE 4

Lupus vulgaris of the ear. Reprinted with permission from reference 85 .

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0010-2016
Permissions and Reprints Request Permissions
Download as Powerpoint

Tables

Generic image for table
TABLE 1

Classification of cutaneous TB and synonymous terms used previously

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0010-2016

Supplemental Material

No supplementary material available for this content.

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error