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Ma. Fatima Lourdes Omangayon, MD, Emmerson Gale S. Vista, MD, FPDS, FPSVI

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Abstract

Introduction:Cutaneous involvement is relatively uncommon representing a small fraction (1-2%) of the localizations of extrapulmonary tuberculosis. Cutaneous TB presents with several clinical forms, wherein one of the most common is scrofuloderma resulting from the direct extension of a tuberculous focus from a deeper structure such as the lymph node into the overlying skin. Tuberculous gumma is a rare form which occurs due to hematogenous spread of the TB bacilli. Although presenting with a wide clinical spectrum, it is believed that the association of diff erent morphologies as well as numerous lesions and sites of cutaneous TB in a same patient is very rare.

Case Report: This is a case of a 20-year-old Filipino male presented with a five-month history of several progressive cutaneous lesions initially presenting as subcutaneous nodules evolving into well-demarcated suppurative painless ulcers which were unresponsive to topical antibiotic. Skin punch biopsy from the medial malleolar area of the right foot revealed dilated blood vessels with a diffuse inflammatory infiltrate of lymphocytes, histiocytes, and few multinucleated giant cells. Clinical and laboratory findings were consistent with cutaneous tuberculosis. Patient was started on anti-Koch’s treatment regimen and presented an excellent response to treatment showing resolution of the skin lesions on the neck and forearms and notable regression of the lesions on the right foot within four (4) months.

Conclusion:This case serves as a reminder that cutaneous tuberculosis can manifest with a wide spectrum of clinical presentation which can mimic diverse dermatological conditions and may present with high rates of negative or equivocal diagnostic testing results. This report highlights the importance of a high index of suspicion in the timely diagnosis and management of tuberculosis in countries wherein tuberculosis remains a significant health burden such as the Philippines.

 

Keywords:Cutaneous tuberculosis, Scrofuloderma, Tuberculous gumma, Metastatic tuberculous abscess

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