Varshney Anupam, Goyal Tarang
Department of Pathology, Muzaffarnagar Medical College, Muzaffarnagar, India.
Ann Saudi Med. 2011 Mar-Apr;31(2):134-9. doi: 10.4103/0256-4947.77495.
There are few reports of cutaneous tuberculosis with immunosuppressed states such as HIV, use of immunosuppressants or malignancy. Diagnosis is thus difficult and despite scientific advances such as polymerase chain reaction, it is frequently missed. Although rare, given its worldwide prevalence and the rising incidence of HIV, it is important for clinicians to recognize the variants and promptly treat the patient.
Retrospective study of all cases of cutaneous tuberculosis diagnosed from October 2007 to November 2009 at an outpatient clinic of a tertiary-care hospital in northern India.
We collected information on the clinical form of disease, histopathology and HIV concurrence rates and looked for differences in presentation between mmunocompetent and immunocompromised states. We also looked for differences and HIV concurrence between immunocompetent and immunocomprised patients. Diagnosis was based on clinical, histopathological and microbiological tests for tuberculosis and a test for HIV.
The overall incidence of cutaneous tuberculosis was 0.7% (131 of 18720 outpatients). HIV concurrence was 9.1% (12 cases) of all cutaneous tuberculosis cases. Most common variants seen were scrofuloderma (36.5%), lupus vulgaris (31%), tuberculosis verruca cutis (12.9%), lichen scrofulosorum (11.4%), papulonecrotic tuberculids (3.8%), erythema nodosum (2.2%) and erythema induratum of Bazin (1.5%).
Cutaneous tuberculosis rates were slightly higher in our study than in other studies from India. HIV co-infection rates were similar to those in other studies. Many atypical morphological forms and presentations were observed in HIV co-infected patients. Due to the varied clinical presentations, physician awareness and a high index of suspicion are necessary to diagnose cutaneous forms of tuberculosis.
关于人类免疫缺陷病毒（HIV）感染、使用免疫抑制剂或患有恶性肿瘤等免疫抑制状态下的皮肤结核报告较少。因此，诊断较为困难，尽管有聚合酶链反应等科学进展，但仍常常漏诊。虽然罕见，但鉴于其全球流行率以及HIV发病率不断上升，临床医生认识到其各种变体并及时治疗患者非常重要。
对2007年10月至2009年11月在印度北部一家三级医院门诊诊断的所有皮肤结核病例进行回顾性研究。
我们收集了疾病临床形式、组织病理学和HIV并发率的信息，并寻找免疫功能正常和免疫功能低下状态之间表现的差异。我们还寻找了免疫功能正常和免疫功能受损患者之间的差异以及HIV并发情况。诊断基于结核病的临床、组织病理学和微生物学检查以及HIV检测。
皮肤结核的总体发病率为0.7%（18720名门诊患者中的131例）。HIV并发率为所有皮肤结核病例的9.1%（12例）。最常见的变体为瘰疬性皮肤结核（36.5%）、寻常狼疮（31%）、疣状皮肤结核（12.9%）、瘰疬性苔藓（11.4%）、丘疹坏死性结核疹（3.8%）、结节性红斑（2.2%）和巴赞硬红斑（1.5%）。
我们研究中的皮肤结核发病率略高于印度的其他研究。HIV合并感染率与其他研究相似。在HIV合并感染患者中观察到许多非典型形态学形式和表现。由于临床表现多样，医生的认识和高度怀疑对于诊断皮肤结核形式很有必要。
