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Lewandowsky's Rosaceiform Eruption: a Form of Cutaneous Tuberculosis Confirmed by PCR in Two Patients.

Conlledo R, Guglielmetti A, Sobarzo M, Woolvett F, Bravo F, González S, Fich F, Vial V - Dermatol Ther (Heidelb) (2014)

Bottom Line: The current problem with diagnosis is the demonstration of bacillus in the skin, especially paucibacillar forms, where sources like polymerase chain reaction (PCR) have improved diagnostic capacity.In paucibacillar forms, when culture and staining are negative and TBC is still suspected, it is recommended to use DNA amplification by PCR for an accurate diagnosis.Both cases bring up the concern about once again bringing Lewandowsky's rosaceiform eruption into the spectrum of cutaneous TBC, and the discussion about the current definition of tuberculid.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, School of Medicine, University of Valparaíso, Hontaneda 2653, Valparaíso, Chile, rodrigoconlledo@hotmail.com.

ABSTRACT

Introduction: Cutaneous tuberculosis (TBC) is a chronic disease caused by Mycobacterium tuberculosis, and is present in less than 1-2% of all TBC cases. The current problem with diagnosis is the demonstration of bacillus in the skin, especially paucibacillar forms, where sources like polymerase chain reaction (PCR) have improved diagnostic capacity.

Case presentation: Two cases of cutaneous TBC are reported. The first patient was 52-year-old woman with facial erythematous papulo-nodular lesions which had been developing for 4 months, and had previously been treated as acne rosacea, with partial response. Histopathological studies showed chronic granulomatous inflammation. TBC was suspected, so PCR was performed, which showed positive for M. tuberculosis. The second case was a 43-year-old woman with a facial rosaceiform plaque which began 6 months previously, and was treated as rosacea without any change for 5 months. Skin biopsy and PCR were positive for TBC. Both cases were treated using primary schedule for TBC, and both presented a favorable response.

Discussion: A clinical profile called Lewandowsky's rosacea-like eruption has been previously described. The condition has been questioned for years and was later removed from the spectrum of tuberculids and cutaneous TBC for not being able to isolate microorganisms in skin samples, a situation that might now change. In paucibacillar forms, when culture and staining are negative and TBC is still suspected, it is recommended to use DNA amplification by PCR for an accurate diagnosis. Both cases bring up the concern about once again bringing Lewandowsky's rosaceiform eruption into the spectrum of cutaneous TBC, and the discussion about the current definition of tuberculid.

No MeSH data available.


Related in: MedlinePlus

Cheek with a rosaceiform plaque, papules and telangiectasies
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Fig5: Cheek with a rosaceiform plaque, papules and telangiectasies

Mentions: A 43-year-old woman presented with a rosaceiform plaque, which had been developing for 6 months, with papules and telangiectasies, and erythematous base in her right cheek (Fig. 5). There was no relevant medical history, or contact with patients with known TBC, and she had been vaccinated with BCG after birth. Treatment for Rosacea was started, with no changes over 5 months. Because of the persistence of the lesions and the poor therapeutic response, skin biopsy and IFD were indicated. Histopathological tests also showed superficial dermis with marked and diffuse lymphocitary infiltrate, with epithelioid histiocytes and formation of granulomas; results that were compatible with tuberculids (Fig. 6) (cytology and histopathology laboratory, Catholic University Health Network). IFD was negative for C3, C1q, IgA, IgG, IgM and fibrin. Similarly to Case 1, presence of M. tuberculosis was suspected as a diagnostic possibility, and so PCR was requested. The technique used was carried out in duplicate, and was consistent in amplification for the sequences of the heat shock protein 65 Kd (generic for Mycobacterium) and IS6110 (specific for MTC) [12]. At the same time, DNA integrity of the skin sample was evaluated by amplification of the human beta-globin gene (positive internal control) and a water-only sample (H2O) to discard the possibility of contamination (negative external control) [13]. Results of the PCR were positive for M. tuberculosis (cytology and histopathology laboratory, Catholic University Health Network). Tests for PPD showed negative results, without erythema or induration (Medical Specialties Center, Carlos Van Buren Hospital, Valparaiso). Treatment with primary schedule was started (using the same schedule as Case 1), showing a rapid response after 15 days of treatment (Fig. 7). Tests for the primary focus did not show the presence of TBC.Fig. 5


Lewandowsky's Rosaceiform Eruption: a Form of Cutaneous Tuberculosis Confirmed by PCR in Two Patients.

Conlledo R, Guglielmetti A, Sobarzo M, Woolvett F, Bravo F, González S, Fich F, Vial V - Dermatol Ther (Heidelb) (2014)

Cheek with a rosaceiform plaque, papules and telangiectasies
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4374068&req=5

Fig5: Cheek with a rosaceiform plaque, papules and telangiectasies
Mentions: A 43-year-old woman presented with a rosaceiform plaque, which had been developing for 6 months, with papules and telangiectasies, and erythematous base in her right cheek (Fig. 5). There was no relevant medical history, or contact with patients with known TBC, and she had been vaccinated with BCG after birth. Treatment for Rosacea was started, with no changes over 5 months. Because of the persistence of the lesions and the poor therapeutic response, skin biopsy and IFD were indicated. Histopathological tests also showed superficial dermis with marked and diffuse lymphocitary infiltrate, with epithelioid histiocytes and formation of granulomas; results that were compatible with tuberculids (Fig. 6) (cytology and histopathology laboratory, Catholic University Health Network). IFD was negative for C3, C1q, IgA, IgG, IgM and fibrin. Similarly to Case 1, presence of M. tuberculosis was suspected as a diagnostic possibility, and so PCR was requested. The technique used was carried out in duplicate, and was consistent in amplification for the sequences of the heat shock protein 65 Kd (generic for Mycobacterium) and IS6110 (specific for MTC) [12]. At the same time, DNA integrity of the skin sample was evaluated by amplification of the human beta-globin gene (positive internal control) and a water-only sample (H2O) to discard the possibility of contamination (negative external control) [13]. Results of the PCR were positive for M. tuberculosis (cytology and histopathology laboratory, Catholic University Health Network). Tests for PPD showed negative results, without erythema or induration (Medical Specialties Center, Carlos Van Buren Hospital, Valparaiso). Treatment with primary schedule was started (using the same schedule as Case 1), showing a rapid response after 15 days of treatment (Fig. 7). Tests for the primary focus did not show the presence of TBC.Fig. 5

Bottom Line: The current problem with diagnosis is the demonstration of bacillus in the skin, especially paucibacillar forms, where sources like polymerase chain reaction (PCR) have improved diagnostic capacity.In paucibacillar forms, when culture and staining are negative and TBC is still suspected, it is recommended to use DNA amplification by PCR for an accurate diagnosis.Both cases bring up the concern about once again bringing Lewandowsky's rosaceiform eruption into the spectrum of cutaneous TBC, and the discussion about the current definition of tuberculid.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, School of Medicine, University of Valparaíso, Hontaneda 2653, Valparaíso, Chile, rodrigoconlledo@hotmail.com.

ABSTRACT

Introduction: Cutaneous tuberculosis (TBC) is a chronic disease caused by Mycobacterium tuberculosis, and is present in less than 1-2% of all TBC cases. The current problem with diagnosis is the demonstration of bacillus in the skin, especially paucibacillar forms, where sources like polymerase chain reaction (PCR) have improved diagnostic capacity.

Case presentation: Two cases of cutaneous TBC are reported. The first patient was 52-year-old woman with facial erythematous papulo-nodular lesions which had been developing for 4 months, and had previously been treated as acne rosacea, with partial response. Histopathological studies showed chronic granulomatous inflammation. TBC was suspected, so PCR was performed, which showed positive for M. tuberculosis. The second case was a 43-year-old woman with a facial rosaceiform plaque which began 6 months previously, and was treated as rosacea without any change for 5 months. Skin biopsy and PCR were positive for TBC. Both cases were treated using primary schedule for TBC, and both presented a favorable response.

Discussion: A clinical profile called Lewandowsky's rosacea-like eruption has been previously described. The condition has been questioned for years and was later removed from the spectrum of tuberculids and cutaneous TBC for not being able to isolate microorganisms in skin samples, a situation that might now change. In paucibacillar forms, when culture and staining are negative and TBC is still suspected, it is recommended to use DNA amplification by PCR for an accurate diagnosis. Both cases bring up the concern about once again bringing Lewandowsky's rosaceiform eruption into the spectrum of cutaneous TBC, and the discussion about the current definition of tuberculid.

No MeSH data available.


Related in: MedlinePlus