Authors: Kristy Elleza R. Evangelista, MD, and Johannes F. Dayrit, MD, FPDS
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.
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.
tuberculosis verrucosa cutis, TVC, cutaneous tuberculosis
- Aliagaoglu C, Atasoy M, Gulec AI, Ozmedir S, Erdem T, Karakuzu A et al. Tuberculosis verrucosa cutis. Experience from eastern Turkey. Saudi Med J. 2007 Dec; 28 (12): 1912
- Sehgal VN, Sehgal R., Bajaj P., Sriviastava, G, Bhattacharya S. Tuberculosis verrucosa cutis (TBVC). J Eur Acad Dermatol Venereol. 2000; 14(4): 319-21
- Santos JB, Figueiredo AR, Ferraz CE, Oliveira MH, Silv PG, Medeiros VL. Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinical aspects- part I. An Bras Dermatol. 2014; 89(2): 219-28.
- Spelta K, Diniz LM. Cutaneous tuberculosis: a 26-year retrospective study in an endemic area of tuberculosis, Vitória, Espírito Santo, Brazil. Rev Inst Med Trop Sao Paulo. 2016 Jul 11;58:49
- Murthy SC, Raghu TY, Suresh T. A study of palmoplantar keratodermas in South India. Int J Dermatol, 2008; 47: 762–64.
- Ho CK, Ho MH, Chong LY. Cutaneous tuberculosis in Hong Kong: an update. Hong Kong Med J . 2006 Aug; 12 (4): 272-7.
- Gruber P .,Whittam LR, Du Vivier A. Tuberculosis verrucosa cutis on the sole of the foot. Clin Exp Dermatol. 2002 May; 27(3): 188-91.
- Afshar K, Manpreet M . Tuberculosis verrucosa cutis. Mayo Clin Proc. 2004 Dec; 79 (12):156
- Iizawa, O, Aiba S, Tagami H. Tuberculosis verrucosa cutis in a tumour‐like form. Br J Dermatol .1991 Jul;125 (1): 79-80.
- Prapanna, P, Srivastava R, Arora VK, Singh N, Bhatia A, Kaur IR. “Immunocytochemical detection of mycobacterial antigen in extrapulmonary tuberculosis.” Diagn Cytopathol. 2014; 42(5): 391-95.
- Lakshmi V, Patil MA, Subhadha K, Himabindu V. Isolation of mycobacteria by BACTEC 460 TB system from clinical specimens. Indian J Med Microbiol . 2006;24:124–26.
- Sharma M., Sethi S, Mishra AK, Chatterjee SS, Wanchu A, Nijhawan, R. Efficacy of an in-house polymerase chain reaction assay for rapid diagnosis of Mycobacterium tuberculosis in patients with tubercular lymphadenitis: Comparison with fine needle aspiration cytology and conventional techniques. Indian J Pathol Microbiol. 2010;53 (4):714–17.
- Sehgal VN, Sardana K, Bajaj P, Bhattacharya SN. Tuberculosis verrucosa cutis: antitubercular therapy, a well‐conceived diagnostic criterion. Int J Dermatol. 2005; 44(3): 230-32.
- Frankel A, Penrose C, Emer J. Cutaneous tuberculosis: a practical case report and review for the dermatologist. J Clin Aesthet Dermatol . 2009; 2(10): 19-27
- Arora S, Arora G, Kakkar S. Cutaneous tuberculosis: a clinico-morphological study. Med J Armed Forces India . 2006; 62(4): 344-47.
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