Scrofuloderma (tuberculosis colliquativa cutis)

Scrofuloderma is a common type of cutaneous tuberculosis characterized by a bluish-red nodule overlying an infected lymph gland, bone or joint that breaks down to form an undermined ulcer with a granulating tissue at the base. Progression of the disease leads to irregular adherent masses, densely fibrous at some places while fluctuant and discharging at others. It heals with a characteristic puckered scarring at the site of infection. The disease is caused by Mycobacterium tuberculosis. Very few pediatric patients with scrofuloderma have been reported. Here we describe a case of scrofuloderma with spine and pulmonary involvement in a 11 year old child which has been rarely described in literature.

Case Reports in Dermatology

This paper reports a case of tuberculous dactylitis and multiple scrofuloderma spreading through the lymph nodes. Scrofuloderma, also known as tuberculosis colliquativa cutis, is a form of cutaneous tuberculosis (TB) that occurs most often in children and young adults and involves the skin over the infection focus (i.e., lymph nodes, bones, or joints). Scrofuloderma can affect the lower limbs and upper arms by spreading osteomyelitis TB on the humerus, wrist, and elbow. This study reports the case of a 19-year-old man who initially developed painful and swollen skin, followed by the appearance of numerous recurring lumps on the left arm and hand and the right foot, as well as the folding right hamstring, over 3 years. The patient had no clinical improvement with antibiotics and excision. Radiography of the left hand showed tuberculous dactylitis. A biopsy of the left arm was performed, and Ziehl-Neelsen staining showed acid-fast bacilli. Mycobacterium tuberculosis was confirmed by a...

F1000Research

Cutaneous tuberculosis (TB) can present in a number of ways, making it difficult to diagnose. It most commonly presents as scrofuloderma, which commonly affects the supra-clavicular region, axilla and the cervical region. All the different presentations of cutaneous TB should be known to clinicians, in order to diagnose it early. The objective of this article is to describe a case of scrofuloderma presenting with different cutaneous lesions at the same time, which were culture negative. We present a 23-year-old male with no known co-morbidities, presenting to us with fever and multiple swellings on the body. Cultures of pus and blood were negative for TB; GeneXpert detected the microorganism. Cutaneous TB, although a rare disease with wide spectrum of cutaneous lesions, should be considered in differential diagnosis of cold abscesses and nodules, especially of the head and neck region.

Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease, 2019

Scrofuloderma, can develop on the skin through direct extension from an endogenous source of tuberculosis such as lymph node. This report presents a case of scrofuloderma in its classical presentation in a 41-yearold man, who suffered from a three-week history of a painless swelling that ulcerated. Physical examination revealed two tender nodules on the left anterior neck and armpit. The diagnosis was confirmed bythe presence of an underlying focus of infection tuberculous lymphadenitis, positive results ofMycobacterium tuberculosis interferon-gamma release assay (IGRA), Xpert MTB/RIF, and histopathological examination. Treatment with anti-tuberculosis regiment resulted in an excellent outcome.

Tropical biomedicine, 2010

Cutaneous tuberculosis, a rare form of extrapulmonary tuberculosis, has a wide variety of clinical presentations and continues to be one of the most important dermatological diseases in developing countries.The sites of predilection are neck, supraclavicular region, axilla, and groin. Single or multiple cutaneous and subcutaneous nodules first appear and breakdown later resulting in undermined ulcers with a purulent discharge, sinuses, and disfiguring scars. We report a multifocal case of scrofuloderma in a 47-year-old immunocompetent man treated successfully with four antituberculotic drugs, albeit lately due to the loss of awareness to the disease.

InterConf

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.

International Journal of Dermatology, 2005

A 12-year-old boy was seen with a discharging ulcer over the thoracic spine on July 5, 2002. The boy was apparently well 4 days before, when his mother accidentally noticed a small boil on the middle of the spine, surrounded by erythema and edema. The swelling increased until it burst 1 day prior to the examination, emitting a purulent discharge. The patient had fever with profuse sweating. There was no history of cough or expectoration, nausea, and/or vomiting. There was a history of recurrent chest pain, which was a consequence of pulmonary pathology, as the boy had been taking treatment for a recurrent chest infection for the past 4 years. The parents had also observed a loss of appetite and weight. The child was never vaccinated with bacillus Calmette–Guérin (BCG). His grandfather had succumbed to pulmonary tuberculosis. A history of tuberculosis was elicited in a family friend, as well as in the next-door neighbors.Examination of the skin surface on the back revealed the presence of a 1.5 cm × 1.5 cm ulcer. It had a purulent discharge. The ulcer was angry looking and had everted, undermined, irregular borders. It was tender to the touch and surrounded by erythema and edema. The ulcer was located at the dorso-lumbar spine (Fig. 1a,b). Smear(s) were prepared from the purulent discharge and were stained for the demonstration of acid-fast bacilli (AFB) with Ziehl-Neelsen stain; they were negative on three occasions. Culture result of the purulent discharge showed no growth after 48 h of incubation at 37 °C aerobically. Also, hematoxylin and eosin-stained sections prepared from the representative margin of the ulcer were studied to illustrate its microscopic pathology. It was characterized by a bizarre collection of epithelioid cells and partial foreign body giant cell formation (Fig. 2a,b). Typical tubercles per se, however, were conspicuous by their absence, as were caseation necrosis and tubercle bacilli.Figure 1. Scrofuloderma before (a) and after (b) antitubercular therapy (ATT)Download figure to PowerPointFigure 1. Scrofuloderma before (a) and after (b) antitubercular therapy (ATT)Download figure to PowerPointFigure 2. Scrofuloderma: bizarre collection of epithelioid cells (a) and a partial foreign body giant cell (b) (hematoxylin and eosin, 40 × 100)Download figure to PowerPointFigure 2. Scrofuloderma: bizarre collection of epithelioid cells (a) and a partial foreign body giant cell (b) (hematoxylin and eosin, 40 × 100)Download figure to PowerPointChest examination revealed bilateral diminished air entry. Tympanic resonance was decreased. In addition, bilateral and asymmetric crackling and crepitations were demonstrated on auscultation. The crepitations were prominent on the right apical and right lower lobe. These were supported by the postero-anterior view roentgenograph of the chest, which revealed prominence of both hila. Patchy heterogeneous infiltration occupying the para-cardiac area and the right apex was conspicuous. Sputum examination and gastric lavage were negative for AFB.Mantoux test with intradermal injection of 0.1 mL SPAN's tuberculin (purified protein derivative (PPD)/5 tuberculin unit (5TU)/0.1 mL) was negative after 72 h. Investigations, including total and differential leukocyte counts, serum biochemistry, and renal and liver function tests, were within the normal range, except for the erythrocyte sedimentation rate, which was 55 mm/1st hour (Westergren). X-Ray of the lumbo-sacral area was negative. Tuberculosis-enzyme-linked immunoabsorbent assays (TB-ELISA) and polymerase chain reaction (PCR) were also inconclusive.A working diagnosis of scrofuloderma was made. Accordingly, antitubercular therapy (ATT), comprising 150 mg of rifampicin, 100 mg of isonicotinic acid hydrazide, and 500 mg of pyrazinamide (Rinizide Forte-DT), was advised for oral administration daily for a continuous 8-month period. A remarkable regression of the skin lesion was recorded after a period of 12 weeks (Fig. 1a,b). Corresponding regression of the lesions of the lungs was also seen clinically, as well as on roentgenograph. Accordingly, the patient was advised to continue the treatment for another 5 months. The patient has successfully completed the schedule of treatment. The skin and lung lesions have completely subsided. Currently, he is under surveillance.

Revista de Patologia Tropical / Journal of Tropical Pathology, 2018

The extrapulmonary forms of tuberculosis are responsible for about 20% of cases. Scrofuloderma is the cutaneous manifestation secondary to infection in some subcutaneous foci. A 33-year-old patient was admitted to the Clinical Hospital with exudative skin lesions on the back and thorax, initiated 10 months previously, associated with daily fever, and constipation. Spine resonance showed a paravertebral pseudotumoral lesion with T4 and T9 invasion, including vertebral canal and sub-ligament extension. The lesions presented fistulas for paravertebral muscles, lung and skin. Polimerase chain reaction (PCR) proved positive for Mycobacterium tubeculosis in the thorax wound secretion, caracterizing tuberculous spondilodiscitis with scrofuloderma. Treatment was initiated with rifampicin, isoniazid, pyrazinamide and ethambutol with important clinical improvement after the first week. The febrile peaks came to an end and there was improvement in the pattern of the cutaneous lesions. The susc...

Acta dermatovenerologica Alpina, Pannonica, et Adriatica, 2021

Cutaneous tuberculosis is caused by Mycobacterium tuberculosis with varied clinical features depending on the dissemination route and host immune status. Scrofuloderma is a type of cutaneous tuberculosis that often occurs in locations where there is an infected lymph node or bone underneath, whereas tuberculous chancre often appears in sites that are prone to trauma. Although several cases have been reported, the coexistence of more than one type of cutaneous tuberculosis is very rare. We report a 21-year-old immunocompetent male with a chronic nonhealing lesion on the left tibia followed by bilateral purulent ulcers on the submandibular area. Acid-fast bacilli examination was positive for M. tuberculosis, and the patient was diagnosed with tuberculous chancre and scrofuloderma, respectively. This case showed the importance of high clinical suspicion of cutaneous tuberculosis and the possibility of the coexistence of more than one type of cutaneous tuberculosis in order to avoid mis...