Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

Lupus vulgaris (LV) is a progressive, chronic form of cutaneous tuberculosis (CTB). The head and neck regions are the most commonly affected sites, followed by the arms and legs. Occurring in unusual sites may pose diagnostic difficulties. Herein, we report a case of LV present on the dorsal aspect of the right hand in a twenty-year-old Saudi male. It was misdiagnosed as leishmaniasis as the patient lived in an area in which it was endemic, and was treated accordingly with no benefit. A skin punch biopsy was taken and the diagnosis of LV was confirmed. The lesion responded well to anti-tubercular therapy (ATT), yet healed with atrophic scarring. Although rare, clinicians must be aware of the importance of considering CTB as an important differential, as misdiagnosis or delayed diagnosis of this entity may eventually cause prolonged morbidity.

Warty cutaneous tuberculosis of the nose: A rare localization

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.

Cutis Tuberculosis

Background: Tuberculosis (TB) is spreading globally, and more than two billion people (about 30% of the world's population) are thought to be infected with M. tuberculosis. Tuberculosis cutis is an extrapulmonary Mycoterium tuberculosis infection that attacks the skin. Research Methods: The writing of this article includes various sources originating from scientific journals and government guidelines and related agencies. Source searches were conducted on the online portals of journal publications such as MedScape, Google Scholar and NCBI (ncbi.nlm.nih.gov). Results: Cutaneous TB can be transmitted through exposure to the lungs or infected aerosols entering the lungs. Cutaneous TB is divided into True Cutaneous TB which consists of primary and secondary TB, and Tuberculid Overall, the treatment of cutaneous TB is similar to that of systemic TB, which tends towards multi-drug therapy. Several anti-tuberculosis drugs such as isoniazid, rifampin, and pyrazinamide have been recommended as drugs for the treatment of cutaneous tuberculosis. It was reported that in a five-year follow-up approximately 12.5% ??of cutaneous TB patients showed relapse after standard anti-TB therapy. Conclusion: To reduce the mortality rate, the public needs to be given education regarding the dangers and ways to prevent TB disease to increase public awareness. More long-term studies are needed to understand the recurrence rate of various cutaneous tuberculosis under current treatment recommendations, especially in immunocompromised patients.

CUTANEOUS TUBERCULOSIS: CASES FROM THE PRACTICE

The publication draws attention to the relevance of dermatological manifestations of tuberculosis. Clinical manifestations mostly are not clear, detection of mycobacteria is a difficult process, and absence of typical histological signs of disease leads to a late diagnosis. Scrofuloderma, lichen scrofulosorum and indurative erythema of Bazin are ones of them. Some cases of cutaneous tuberculosis, principles of diagnosis and the main diagnostic mistakes are discussed.

IFI44L as a Forward Regulator Enhancing Host Antituberculosis Responses

Interferon-induced protein 44-like (IFI44L) gene is a type I interferon-stimulated gene (ISG) that plays a critical role in antiviral activity and constitutes a promising diagnostic marker. However, its precise role and function in tuberculosis have not been unveiled. This study showed that IFI44L acts as an antimicrobial target and positive modulator in human macrophages. Knockdown of IFI44L led to increased Mycobacterium tuberculosis intracellular survival. Moreover, IFI44L was significantly upregulated, and it restricted the intracellular survival of M. tuberculosis H37Rv strains at 72 h after rifampicin treatment. Individuals with cutaneous tuberculosis (CTB) were found to have significantly higher IFI44L expression after 6 months of rifampicin therapy than after only 1 month. These results demonstrated that IFI44L induced positive regulation and clearance of M. tuberculosis from human macrophages. This antimicrobial activity of IFI44L makes it a possible target for therapeutic applications against M. tuberculosis.

Zinc-responsive acral hyperkeratosis as a mimicker of cutaneous tuberculosis

Zinc-responsive acral hyperkeratosis is regarded as a novel entity masquerading numerous skin disorders, such as psoriasis, acral necrolytic erythema, and tuberculosis. Tuberculosis itself is a great imitator and so is its cutaneous form. Herein, we present the case of a female misdiagnosed as a case of tuberculosis verrucosa cutis due to clinical, biochemical, and histopathological features. The patient completed a full course of anti-tubercular therapy without an improvement and showed a dramatic response after a therapeutic trial of oral zinc. Thus, the patient was diagnosed as a case of zinc-responsive acral hyperkeratosis. In any form of acral hyperkeratotic lesions, zinc-responsive acral hyperkeratosis must be considered as a differential diagnosis.

Tuberculosis Verucossa Cutis of Hand: A Case Report

Tuberculosis verrucosa cutis (TBVC) is exogenous paucibacillary cutaneous tuberculosis (CTB) and is the third commonest type of CTB. Clinically, TBVC usually begins as isolated or multiple warty papules, and soon acquires a verrucous plaque and are usually located in the extremities. Here we report a case of 41-year-old South Indian woman presenting with occasional pruritus, erythematous scaly nodules and warty plaques on the back of right hand following nail prick. A positive Mantoux test, skin biopsy showing granuloma and related epidemiologic, clinical and histopathologic data with an excellent response of patient to the treatment confirmed TBVC.

Practical Review of Diagnosis and Management of Cutaneous Tuberculosis in Indonesia

Tuberculosis is a life-threatening infectious disease that remains a high incidence worldwide. The classification of tuberculosis can be divided into two forms, i.e., pulmonary and extrapulmonary. The pathogenesis of tuberculosis depends on the cell-mediated immunity of the host. One of the variants of extrapulmonary tuberculosis is cutaneous tuberculosis, that commonly found in Indonesia. Based on the bacterial load, cutaneous tuberculosis is divided into two types, multibacillary and paucibacillary tuberculosis. Diagnosis of cutaneous tuberculosis often requires specific investigations, such as histopathology, Ziehl-Neelsen staining, Interferon-Gamma Release Assays, enzyme-linked immunosorbent assay serology, and Polymerase Chain Reaction. The treatment principle for cutaneous tuberculosis is the same as the treatment for pulmonary tuberculosis, which consists of an intensive and maintenance phase.