Authors: Kristy Elleza R. Evangelista, MD, and Johannes F. Dayrit, MD, FPDS

Abstract

Introduction: Tuberculosis verrucosa cutis (TVC) is a cutaneous form of paucibacillary tuberculosis in individuals with moderate to high degree of immunity to Mycobacterium tuberculosis infection. This report highlights that TVC may present with atypical morphology and mimic other etiologies of diffuse plantar keratoderma.

Case Summary. A 27-year-old Filipino female presented with multiple skin-colored to erythematous verrucous plaques on the right foot for 22 years. Dermatological examination revealed skin-colored to erythematous verrucous plaques on the dorsolateral and plantar aspect of the right foot and differential diagnosis were tinea pedis, lichen simplex chronicus and giant verruca. Mantoux reaction reading after 48 h was strongly positive at 32 mm. A 4mm punch biopsy showed pseudoepitheliomatous hyperplasia of the epidermis, papillary fibrosis and a moderately dense lichenoid inflammatory infiltrate consisting of histiocytes, lymphocytes and multinucleated giant cells. The histopathological diagnosis was TVC. Patient was started on standard multi-drug antituberculosis regimen for 6 months and noted complete resolution of the lesions.

Conclusion: TVC masquerading as plantar keratoderma, to the best of our knowledge, has rarely been reported. Correlation of the histopathologic findings and supported by an exaggerated Mantoux skin test reaction may enable a definite diagnosis of TVC. A dramatic response to anti-tuberculosis medications further supported our diagnosis.

Citation

Evangelista, KE & Dayrit, J. (2017). Tuberculosis Verrucosa Cutis presenting as diffuse plantar keratoderma in a Filipino female. Journal of the Philippine Dermatological Society, 26(2), 78-80.

Keywords

tuberculosis verrucosa cutis, TVC, cutaneous tuberculosis

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