Owczarek Witold, Targowski Tomasz, Łebkowska Katarzyna, Paluchowska Elwira
Klinika Dermatologii Centralnego Szpitala Klinicznego MIN, Wojskowy Instytut Medyczny w Warszawie, Warszawa.
Pneumonol Alergol Pol. 2009;77(4):417-21.
Cutaneous tuberculosis is a specific form of tuberculosis, with various clinical pictures and resulting from either endo- or exogenous way of infection, immunological mechanisms and unfavourable conditions for mycobacterium development. The atypical course and symptoms of the disease may cause difficulties in obtaining proper diagnosis and, in consequence, result in delayed onset of appropriate treatment. When diagnosing cutaneous tuberculosis, a broad spectrum of differential diagnoses should be applied, taking into account other diseases, such as, among others, leishmaniasis, actinomycosis, leprosy or deep mycoses. In this report, a case of lymph node tuberculosis and of colliquative tuberculosis of the skin, at first erroneously diagnosed as actinomycosis, complicated by multiform erythema. In the reported case, no tuberculous bacilli were identified in bacteriological evaluations of bioptates, collected from the skin changes. The final diagnosis of the disease was determined by the presence of specific granulation tissue in the last of performed histopathological studies, as well as by hypersensitivity to tuberculin and the presence of mycobacterial DNA in PCR evaluation. According to the authors, in case of clinically suspected cutaneous tuberculosis, repeated (several) histopathological studies of samples from observed changes seem to be fairly justified. The results of histopathological studies should be completed by one of the methods of oligomycobacterial material evaluation, e.g. by identification of mycobacterial genetic material by means of nucleic acid amplification in the PCR method.
皮肤结核是结核病的一种特殊形式，有多种临床表现，由内源性或外源性感染途径、免疫机制以及不利于分枝杆菌生长的条件引起。该疾病不典型的病程和症状可能导致难以获得正确诊断，进而导致适当治疗延迟开始。诊断皮肤结核时，应进行广泛的鉴别诊断，考虑其他疾病，如利什曼病、放线菌病、麻风病或深部真菌病等。在本报告中，一例淋巴结结核和皮肤液化性结核起初被误诊为放线菌病，并并发多形红斑。在该报告病例中，从皮肤病变处采集的活检组织细菌学评估未发现结核杆菌。疾病的最终诊断取决于最后一次组织病理学研究中特定肉芽组织的存在，以及结核菌素超敏反应和聚合酶链反应（PCR）评估中分枝杆菌DNA的存在。作者认为，对于临床怀疑为皮肤结核的病例，对观察到的病变样本进行多次组织病理学研究似乎是合理的。组织病理学研究结果应通过一种寡分枝杆菌材料评估方法来完善，例如通过PCR方法中的核酸扩增来鉴定分枝杆菌遗传物质。
