Authors:Marie Lourenz M. Racadio MD; Roy Lawrence S. Paredes MD; Audi MD, Marie Socouer M. Oblepias MD
Introduction: Tuberculosis Verrucosa Cutis (TVC) occurs in previously exposed individuals to TVC due to exogenous infection with Mycobacterium tuberculosis or Mycobacterium bovis. The areas of predilection for TVC in children are the lower extremities, while fingers and hands are common in adults. The lesions of TVC are generally asymptomatic and appear as small papules with a purple inflammatory halo that slowly evolve into hyperkeratotic plaques over several months to years. A 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. Six months prior to consult, the patient consistently used mupirocin ointment twice daily with no improvement. Examination of other organ systems is unremarkable. Past medical history reveals an untreated primary pulmonary tuberculosis in childhood. Purified protein derivative test was positive. Biopsy showed pseudocarcinomatous hyperplasia of the epidermis with collections of neutrophils in the subcorneal layer. The dermis reveals histiocytes, lymphocytes, plasma cells, and multinucleated giant cells, consistent with tuberculosis verrucosa cutis. The patient completed antituberculosis therapy for 6 months with complete resolution of the lesion.
Conclusion: Tuberculosis verrucosa cutis is a rare type of cutaneous TB in children and adolescents. It has varied manifestations; hence, it is 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 fairly uncommon. Thus, knowledge of this possibility and good clinical acumen are necessary to make a definite diagnosis.
Racadio MLM, Paredes RLS, Audi, Oblepias MSM. A warty plaque on the hand of a teenager. J Phil Dermatol Soc 2019, 28(1), 62-64
warty plaque, M. tuberculosis, Tuberculosis verrucosa cutis
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