A warty plaque on the hand of a 13-year old male student

Authors: Marie Lourenz M. Racadio, MD, Roy Lawrence S. Paredes, MD, Marie Socouer M. Oblepias, MD

Abstract

Introduction: Tuberculosis Verrucosa Cutis (TVC) occurs in previously sensitized individuals due to exogenous reinfection with Mycobacterium tuberculosis or Mycobacterium bovis. The sites of predilection for TVC in children are the lower extremities. In adults, fingers and hands are involved. The lesions of TVC typically are asymptomatic and start as small papules with a purple inflammatory halo that slowly progress to verrucous or hyperkeratotic plaques over several months to years. Multi drug anti tuberculosis regimen is the treatment of choice.

Case Summary: We present a case of a 13-year old male, student, with a 9-year history of few erythematous asymptomatic papules on the thenar area of the right hand gradually enlarging into a solitary well defined hyperkeratotic plaque with raised border. There was no history of trauma on the involved area. Examination of other organ systems was unremarkable. Six months prior to consult, patient was consistently using Mupirocin ointment twice daily with no improvement. Biopsy showed pseudocarcinomatous hyperplasia of the epidermis with collections of the neutrophils in the subcorneal layer. The dermis reveals histiocytes, lymphocytes, plasma cell and multinucleated giant cells, consistent with Tuberculosis Verrucosa Cutis.

Conclusion: Tuberculosis Verrucosa Cutis is a less common form of cutaneous tuberculosis in children and adolescents. It has a varied manifestation hence sometimes misdiagnosed. Review of literature has shown reports of TVC in children and adolescents involving the lower extremities. TVC presenting on the hand of an adolescent is rare. Thus, knowledge of this possibility and good clinical acumen is necessary to make a diagnosis

 

Citation

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Keywords

Tuberculosis Verrucosa Cutis, Cutaneous tuberculosis

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