scholarly journals Lupus Vulgaris: A Diagnostic Challenge

2021 ◽  
Vol 79 (1) ◽  
pp. 75-77
Author(s):  
Hisabella Lorena Simões Porto ◽  
Isabela Alves Guerra ◽  
Barbara Figueiredo Bastos ◽  
Marina Ferreira ◽  
Marcelino Pereira Martins Neto ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Mycobacterium Tuberculosis Complex ◽  
Immunocompetent Patient ◽  
Tuberculosis Complex ◽  
Lupus Vulgaris ◽  
Diagnostic Challenge ◽  
Cutaneous Tuberculosis ◽  
Important Differential Diagnosis ◽  
Clinical Variant ◽  
The Face

Lupus vulgaris is a clinical variant of cutaneous tuberculosis, a rare subtype of extrapulmonary infection caused by the Mycobacterium tuberculosis complex. A paucibacillary form associated with high degrees of immunity, predominantly in the face, may present several clinical and histopathological differential diagnoses, which makes its diagnosis challenging. We present a case of lupus vulgaris in an immunocompetent patient, whose initial clinical presentation and histopathology did not suggest the condition. The objective is to highlight the relevance of the hypothesis of cutaneous tuberculosis as an important differential diagnosis, especially in endemic areas.

Migraine With Isolated Facial Pain: A Diagnostic Challenge

Cephalalgia ◽  
2007 ◽  
Vol 27 (11) ◽  
pp. 1278-1282 ◽  
Author(s):  
M Obermann ◽  
D Mueller ◽  
M-S Yoon ◽  
L Pageler ◽  
HC Diener ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Neuronal Plasticity ◽  
Facial Pain ◽  
Clinical Presentation ◽  
Preventive Treatment ◽  
Diagnostic Challenge ◽  
Nociceptive Processing ◽  
The Face ◽  
Β Blockers ◽  
Pain Localization

We present a series of seven migraine patients with typical features of a migraine attack without aura, but atypical pain localization in the face in one or both of the lower two distributions of the trigeminal nerve (V2 and V3). All of them responded well to triptans. Three patients responded to preventive treatment for migraine with β-blockers ( n = 2) or valproic acid ( n = 1). These cases underline the heterogenic clinical presentation of migraine, which is sometimes difficult to diagnose even for headache specialists, and broaden the pathophysiological understanding of trigeminal nociceptive processing in migraine in the light of neuronal plasticity.

scholarly journals LUPUS VULGARIS DENGAN LESI DISEMINATA

2015 ◽  
Vol 7 (3) ◽  
Author(s):  
Nana N. Jayadi ◽  
Niken Ernaningtyas ◽  
Nurdjannah J. Niode ◽  
Marthen C. P. Wongkar
Keyword(s):  
Wound Care ◽  
Giant Cells ◽  
Lupus Vulgaris ◽  
Open Wound ◽  
Cutaneous Tuberculosis ◽  
Left Neck ◽  
The Face ◽  
Night Sweats ◽  
History Of ◽  
Erythematous Plaques

Abstract: Lupus vulgaris (LV) is a chronic progressive form of paucibacillary cutaneous tuberculosis. Lesion is usually solitary in the form of nodes or erythematous plaques with an apple-jelly sign on diascopy. Disseminated LV is a rare form of cutanoeus tuberculosis with multiple lesions in several body areas. We reported a male of 40 years old with a suppurative wound on the left neck and reddish nodules on the face, neck, trunk, and limbs along with fever, night sweats, weight loss, and history of previous TB infections. There were multiple erythematous nodules and painful suppurating ulcers with enlargement of several lymph nodes. Apple-jelly sign appeared on diascopy. The FNAB showed specific granulamatous inflammation for TB with lymphocytes, epitheloid macrophages, and multinucleated giant cells. The histopathological finding showed tubercles surrounded by macrophages and lymphocytes. Anti-tuberculosis drugs category I were given for 6 months, ofloxacin, and open wound care compressed with NaCl 0.9%. In the third month of observation, there was significant improvement. Conclusion: This case was diagnosed as lupus vulgaris based on the history of lymphadenitis TB and scrofuloderma, lesions in several body area with positive diascopy test, the FNAB as well as the histopathologic result supporting the diagnosis of tuberculosis, and there was significant improvement after treatment with antiTB drugs.Keywords: lupus vulgaris, diseminata, tuberculosis, ofloksasinAbstrak: Lupus vulgaris (LV) merupakan tuberkulosis (TB) kutis pausibasiler kronis dan progresif. Lesi biasanya soliter, berupa nodus atau plak eritematosa dengan gambaran apple-jelly pada diaskopi. Lupus vulgaris diseminata merupakan bentuk TB kutis yang jarang ditemukan dengan lesi multipel pada beberapa area tubuh secara bersamaan. Kami melaporkan seorang laki-laki, 40 tahun, dengan luka bernanah pada leher kiri dan benjolan-benjolan kemerahan pada wajah, leher, badan, dan tungkai disertai demam, keringat malam, penurunan berat badan dan riwayat infeksi tuberkulosis sebelumnya. Pada pemeriksaan fisik tampak nodus eritematosa multipel disertai ulkus bernanah dan pembesaran beberapa kelenjar getah bening. Gambaran apple-jelly tampak pada diaskopi. Pemeriksaan FNAB menunjukkan gambaran radang granulomatik spesifik TB dengan adanya sel-sel radang limfosit, kelompok makrofag epiteloid, dan sel-sel datia Langhans. Pemeriksaan histopatologis memberikan gambaran tuberkel yang dikelilingi oleh makrofag dan limfosit. Terapi diberikan berupa OAT kategori I selama 6 bulan, ofloksasin, dan kompres terbuka dengan NaCL 0,9%. Pada bulan ketiga tampak perbaikan signifikan. Simpulan: Pada kasus ini, diagnosis lupus vulgaris ditegakkan berdasarkan adanya riwayat limfadenitis TB dan skrofuloderma, lesi di beberapa area tubuh sekaligus dengan pemeriksaan diaskopi positif, gambaran FNAB dan histopatologis menunjang diagnosis TB, dan pengobatan dengan OAT memberikan perbaikan bermakna.Kata kunci: lupus vulgaris, diseminata, OAT, ofloksasin

scholarly journals Tuberculosis verrucosa cutis: case report of a diagnostic challenge

2018 ◽  
Vol 4 (2) ◽  
pp. 265
Author(s):  
Vasudha A. Belgaumkar ◽  
Ravindranath B. Chavan ◽  
Prernaa R. Suryataley ◽  
Aarti S. Salunke ◽  
Pallavi P. Patil ◽  
...  
Keyword(s):  
Case Report ◽  
Antitubercular Therapy ◽  
The Other ◽  
Cell Mediated Immunity ◽  
Lupus Vulgaris ◽  
Diagnostic Challenge ◽  
Cutaneous Tuberculosis ◽  
Internal Focus ◽  
Lymphatic Route

<p class="abstract">Cutaneous tuberculosis occurs by either exogenous inoculation in a previously sensitized or non-immune host or endogenous spread from an internal focus by contiguous, hematogenous or lymphatic route. Inoculation occurs at sites of minor wounds or abrasions, sometimes from the patient’s own sputum. Cutaneous tuberculosis includes lupus vulgaris and tuberculosis verrucosa cutis (TVC) at one end and scrofuloderma and tuberculosis cutis orificialis at the other end with decrease in cell-mediated immunity across the spectrum. Of various cutaneous forms, we report a case of tuberculosis verrucosa cutis in a 14 year old girl who presented with a hyperpigmented verrucous plaque over foot since three years. Histopathological characteristics, GeneXpert and response to antitubercular therapy confirmed the diagnosis.</p><p class="abstract"> </p>

scholarly journals Genomic Interrogation of the Dassie Bacillus Reveals It as a Unique RD1 Mutant within the Mycobacterium tuberculosis Complex

2004 ◽  
Vol 186 (1) ◽  
pp. 104-109 ◽  
Author(s):  
Serge Mostowy ◽  
Debby Cousins ◽  
Marcel A. Behr
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Mycobacterium Bovis ◽  
Dna Content ◽  
Clinical Presentation ◽  
Mycobacterium Tuberculosis Complex ◽  
Biological Significance ◽  
The Other ◽  
Tuberculosis Complex ◽  
Procavia Capensis ◽  
Mycobacterium Microti

ABSTRACT Despite their remarkable genetic homology, members of the Mycobacterium tuberculosis complex express very different phenotypes, most notably in their spectra of clinical presentation. For example, M. tuberculosis is regarded as pathogenic to humans, whereas members having deleted RD1, such as Mycobacterium microti and Mycobacterium bovis BCG, are not. The dassie bacillus, an infrequent variant of the M. tuberculosis complex characterized as being most similar to M. microti, is the causative agent of tuberculosis (TB) in the dassie (Procavia capensis). Intriguingly, the dassie bacillus is not pathogenic to rabbits or guinea pigs and has never been documented to infect humans. Although it was identified more than a half-century ago, the reasons behind its attenuation are unknown. Because large sequence polymorphisms have presented themselves as the most obvious genomic distinction among members of the M. tuberculosis complex, the DNA content of the dassie bacillus was interrogated by Affymetrix GeneChip to identify regions that are absent from it but present in M. tuberculosis H37Rv. Comparison has led to the identification of nine regions of difference (RD), five of which are shared with M. microti (RDs 3, 7, 8, 9, and 10). Although the dassie bacillus does not share the other documented deletions in M. microti (RD1mic, RD5mic, MID1, MID2, and MID3), it has endured unique deletions in the regions of RD1, RD5, N-RD25, and Rv3081-Rv3082c (virS). RD1das, affecting only Rv3874-Rv3877, is the smallest natural deletion of the RD1 region uncovered and points to genes within this region that are likely implicated in virulence. Newfound deletions from the dassie bacillus are discussed in relation to their evolutionary and biological significance.

scholarly journals Warty cutaneous tuberculosis of the nose: A rare localization

2022 ◽  
Vol 13 (1) ◽  
pp. 50-52
Author(s):  
Moussa Doulla ◽  
Laouali Salissou ◽  
Nina Korsaga/Some ◽  
Maimouna Mamadou Ouedraogo ◽  
Larabou Aminou ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Protocol ◽  
Tuberculosis Treatment ◽  
Tuberculosis Complex ◽  
Diagnostic Challenge ◽  
Cutaneous Tuberculosis ◽  
Extra Pulmonary ◽  
Surface Spreading

Cutaneous tuberculosis is a rare, extra-pulmonary form of tuberculosis caused by mycobacteria of the tuberculosis complex. It is characterized by clinical polymorphism often posing a difficult diagnostic challenge. Herein, we report a case of cutaneous tuberculosis in its warty form located on the nose. This was a 57-year-old patient who was infected in the classroom three months previously while taking lessons from a woman with pulmonary tuberculosis. A facial examination revealed a blackish, papillomatous patch invading almost the entire nose, with a keratotic surface spreading over the wings of the nose. The diagnosis of verrucous tuberculosis was reached on the basis of epidemiological, clinical, and paraclinical arguments. Under anti-tuberculosis treatment for six months, the lesion had healed without sequelae. The diagnosis of verrucous cutaneous tuberculosis must be established in the presence of any chronic and crusty lesion. The management responds to the treatment protocol for all forms of tuberculosis.

scholarly journals A case report of transmission and disease caused by Mycobacterium caprae and Mycobacterium bovis in Lima, Peru

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amber Shrestha ◽  
Janeth Picoy ◽  
Arturo Torres ◽  
David A. Moore ◽  
Robert H. Gilman ◽  
...  
Keyword(s):  
Animal Species ◽  
Clinical Presentation ◽  
Mycobacterium Tuberculosis Complex ◽  
Population Level ◽  
Convincing Evidence ◽  
Tuberculosis Complex ◽  
Case Presentation ◽  
Clinical Presentations ◽  
Wide Range ◽  
Causative Agents

Abstract Background The Tuberculosis (TB) burden in Peru is significant with respect to both disease morbidity and mortality. Furthermore the recent diversification of farming enterprise to include a wide range of animal species has necessitated the consideration of members of the Mycobacterium Tuberculosis Complex (MTBC) with the potential for zoonotic transmission. M. bovis and M. caprae, a lesser known member of the MTBC exhibit an exceptionally wide host spectrum in animals and are capable of causing disease in humans. M. bovis has a predictable resistance profile which includes resistance to pyrazinamide. Thus, failure to identify M. bovis as the causative agent in reported TB cases leads to higher levels of treatment failure and contributes to the transmission of drug-resistant TB. Case presentation Reported here are the clinical presentations, investigations and treatment histories of two patients identified from a population level genotyping study in Lima, Peru that were at the time of treatment thought to be M. tuberculosis patients but in retrospect were spectated using whole genome sequencing as M. caprae and M. Bovis. Conclusions The cases reported here constitute convincing evidence that M. caprae and M. bovis are causative agents of TB infection in humans in Peru and underscore the importance of species-level MTBC member identification to effectively control and treat zoonotic TB. Furthermore these cases highlight the challenges of using clinical risk factors to identify cases of zoonotic TB in humans as their clinical presentation and transmission history is often difficult to distinguish from anthroponotic TB.

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