Cutaneous Tuberculosis: A Clinicopathological Study in A Tertiary Care Hospital

Clinicopathology of Cutaneous Tuberculosis

Authors

  • Humaira Talat Department of Dermatology, Dow University of Health Sciences, Karachi, Pakistan
  • Neha Rana Department of Dermatology, Dow University of Health Sciences, Karachi, Pakistan
  • Wafia Sibghatullah Department of Dermatology, Dow University of Health Sciences, Karachi, Pakistan
  • Batool ur Rehman Department of Dermatology, Dow University of Health Sciences, Karachi, Pakistan
  • Reema Mirza Department of Dermatology, Dow University of Health Sciences, Karachi, Pakistan
  • Zuha Saleem Department of Dermatology, Dow University of Health Sciences, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i06.1558

Keywords:

Cutaneous Tuberculosis, Histopathology, Lupus Vulgaris, Scrofuloderma, Giant Cell Granuloma

Abstract

Tuberculosis (TB) is a chronic disease that can affect multiple organs including, the skin. Cutaneous TB poses a great challenge to dermatologists due to its varied clinical presentations and non-specific histopathological findings. Objective: To determine the frequency of clinicopathological patterns of Cutaneous Tuberculosis in children and adults in a Tertiary Care Hospital. Methods: A descriptive cross-sectional study included 63 patients diagnosed with Cutaneous TB at the Department of Dermatology, Dr. Ruth KM Pfau Civil Hospital, Karachi, Pakistan from January 2020 to December 2022. All the patients were clinically evaluated and histopathological features were recorded. Results: The common age group was 21-30 years, with male predominance. Lupus Vulgaris was the most common clinicopathological type in 46 cases (73%), followed by Scrofuloderma in 9 cases (14.3%). Tuberculous Verrucosa cutis and Tuberculous Gumma accounted for 4.8% of cases, while Acute Military Tuberculosis and Tuberculous Panniculitis accounted for 1.6% of cases. The most predominant morphology of the lesion was Erythematous Plaque (36.5%) and the most commonly affected site was face (30.2%). Epitheloid Granuloma with langerhans giant cells were typically present in most of the cases, with Caseous Necrosis more predominantly seen in Scrofuloderma (44.4%), TB Gumma (66.6%) and Acute Military TB (100%). Conclusions: Lupus Vulgaris is the most common presentation of Cutaneous TB followed by Scrofuloderma. Epitheloid Granuloma with langerhans giant cells, with or without Caseous Necrosis is the predominant histopathological presentation. Clinical and histopathological assessment is crucial for an appropriate diagnosis.

References

Jilani TN, Avula A et al. Active Tuberculosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

Netikul T, Palittapongarnpim P, Thawornwattana Y, Plitphonganphim S. Estimation of the global burden of Mycobacterium tuberculosis lineage 1. Infection, Genetics and Evolution. 2021 Jul; 91: 104802. doi: 10.1016/j.meegid.2021.104802. DOI: https://doi.org/10.1016/j.meegid.2021.104802

Chakaya J, Khan M, Ntoumi F, Aklillu E, Fatima R, Mwaba P et al. Global Tuberculosis Report 2020–Reflections on the Global TB burden, treatment and prevention efforts. International Journal of Infectious Diseases. 2021 Dec; 113: S7-12. doi: 10.1016/j.ijid.2021.02.107. DOI: https://doi.org/10.1016/j.ijid.2021.02.107

Gopalaswamy R, Dusthackeer VA, Kannayan S, Subbian S. Extrapulmonary tuberculosis—an update on the diagnosis, treatment and drug resistance. Journal of Respiration. 2021 May; 1(2): 141-64. doi: 10.3390/jor1020015. DOI: https://doi.org/10.3390/jor1020015

Tahseen S, Khanzada FM, Baloch AQ, Abbas Q, Bhutto MM, Alizai AW et al. Extrapulmonary tuberculosis in Pakistan-A nation-wide multicenter retrospective study. PLOS One. 2020 Apr 28;15(4):e0232134. doi: 10.1371/journal.pone.0232134. DOI: https://doi.org/10.1371/journal.pone.0232134

Brito AC, Oliveira CM, Unger DA, Bittencourt MD. Cutaneous tuberculosis: epidemiological, clinical, diagnostic and therapeutic update. Anais Brasileiros de Dermatologia. 2022 Apr; 97: 129-44. doi: 10.1016/j.abd.2021.07.004.

Nguyen KH, Alcantara CA, Glassman I, May N, Mundra A, Mukundan A et al. Cutaneous Manifestations of Mycobacterium tuberculosis: a literature review. Pathogens. 2023 Jul; 12(7): 920. doi: 10.3390/pathogens12070920. DOI: https://doi.org/10.3390/pathogens12070920

Roelan T. Practical Review of diagnosis and management of cutaneous tuberculosis in Indonesia. European Journal of Medical and Health Sciences. 2021 Sep; 3(5): 25-30. doi: 10.24018/ejmed.2021.3.5.1042. DOI: https://doi.org/10.24018/ejmed.2021.3.5.1042

Kaul S, Jakhar D, Mehta S, Singal A. Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment. Journal of the American Academy of Dermatology. 2023 Dec; 89(6): 1107-19. doi: 10.1016/j.jaad.2021.12.064. DOI: https://doi.org/10.1016/j.jaad.2021.12.064

Sharquie KE and Jabbar RI. The picture of cutaneous tuberculosis today: New diverse clinical manifestations in the absence of the old lupus vulgaris in a series of 72 patients. Journal of Pakistan Association of Dermatologists. 2023 Mar; 33(1): 9-17.

Zafar MN, Memon MA, Agha MA, Agha SA, Hashim Y, Mirza T et al. Pattern of cutaneous tuberculosis as identified by morphological study of skin lesions at Jinnah postgraduate medical center, Karachi. Gomal Journal of Medical Sciences. 2010; 8(1).

Maghwal N, Jain VK, Chouhan C, Rao P, Choudhary P. A clinicopathological pattern of cutaneous tuberculosis and HIV concurrence in western Rajasthan. The International Journal of Mycobacteriology. 2020 Oct; 9(4): 429-34. doi: 10.4103/ijmy.ijmy_183_20. DOI: https://doi.org/10.4103/ijmy.ijmy_183_20

Sediadini A, Gunawan H, Hidayah RM. Clinicodemographic and Laboratory Characteristics of Cutaneous Tuberculosis at Tertiary Referral Hospital in West Java, Indonesia. Journal of General-Procedural Dermatology & Venereology Indonesia. 2022; 6(2): 2. doi: 10.7454/jdvi.v6i2.1001. DOI: https://doi.org/10.7454/jdvi.v6i2.1001

Ramya DN, Kumar VK, Kumari AV, Sreedevi L, Begum J. A Clinico-Epidemiological Study on Cutaneous Tuberculosis in a Tertiary Care Hospital in the Era of Decreased Incidence. European Journal of Cardiovascular Medicine. 2024 Jan; 14(1).

Patil SB, Dhage SM, Kangate SV, Umap PS, Khan S, Rudra P. Clinico-Histological Correlation of Cutaneous Tuberculosis–A Two Years Study of a Rare Dermatological Lesion. 2020 May; 11(5): 38605-38608. doi:

Supekar BB, Wankhade VH, Singh RP, Ghanate TD, Bhat D. Clinical spectrum of cutaneous tuberculosis in Central India: A retrospective study. Indian Dermatology Online Journal. 2021 Nov; 12(6): 826-33. DOI: https://doi.org/10.4103/2229-5178.330811

Parajuli N, Karki A, Dhungana A. Cutaneous Tuberculosis among Patients Presenting to Dermatology Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA: Journal of the Nepal Medical Association. 2023 Jan; 61(257): 1. doi: 10.31729/jnma.7930. DOI: https://doi.org/10.31729/jnma.7930

Brito AC, Oliveira CM, Unger DA, Bittencourt MD. Cutaneous tuberculosis: epidemiological, clinical, diagnostic and therapeutic update. Anais Brasileiros de Dermatologia. 2022 Apr; 97: 129-44. doi: 10.1016/j.abd.2021.07.004. DOI: https://doi.org/10.1016/j.abd.2021.07.004

Singal A, Kaur I, Jakhar D, Pandhi D, Grover C, Gandhi V. Clinicoepidemiological characteristics of cutaneous tuberculosis in 1458 Indian patients: a retrospective analytical study from a tertiary care center. International Journal of Dermatology. 2022 Aug; 61(8): 1012-22. doi: 10.1111/ijd.16267. DOI: https://doi.org/10.1111/ijd.16267

Saha PK and Prakash KS. Clinical profile of cutaneous tuberculosis in a tertiary care teaching hospital in Eastern Bihar. International Journal of Contemporary Medical Research. 2020; 7(4): 1-3. doi: 10.21276/ijcmr.2020.7.4.25. DOI: https://doi.org/10.21276/ijcmr.2020.7.4.25

Hammami F, Koubaa M, Rekik K, Smaoui F, Marrakchi C, Jemaa MB. Cutaneous tuberculosis in Southern Tunisia: clinical and therapeutic particularities. Sri Lankan Journal of Infectious Diseases. 2022 Mar; 12(1). doi: 10.4038/sljid.v12i1.8426. DOI: https://doi.org/10.4038/sljid.v12i1.8426

Downloads

Published

2024-06-30
CITATION
DOI: 10.54393/pjhs.v5i06.1558
Published: 2024-06-30

How to Cite

Talat, H., Rana, N., Sibghatullah, W., Rehman, B. ur, Mirza, R., & Saleem, Z. (2024). Cutaneous Tuberculosis: A Clinicopathological Study in A Tertiary Care Hospital: Clinicopathology of Cutaneous Tuberculosis . Pakistan Journal of Health Sciences, 5(06), 47–51. https://doi.org/10.54393/pjhs.v5i06.1558

Issue

Section

Original Article

Plaudit