Mann Danielle, Sant'Anna Flávia Marinho, Schmaltz Carolina Arana Stanis, Freitas Dayvison Francis Saraiva, Rolla Valeria Cavalcanti, Cavalcante Solange Cesar, Gutierrez-Galhardo Maria Clara
Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil.
Mem Inst Oswaldo Cruz. 2018 Jul 26;113(9):e180184. doi: 10.1590/0074-02760180184.
Cutaneous tuberculosis (CTB) is a rare extrapulmonary form of tuberculosis (TB). Despite the increase in the number of cases of TB and HIV, few cases of CTB have been reported.
To describe CTB cases among patients with HIV infection from a cohort with tuberculosis.
We describe a series of 15 CTB and HIV cases, based on secondary data from 2000 to 2016. Diagnosis was based on isolation of Mycobacterium tuberculosis in culture or clinical response to anti-tuberculous treatment associated with positive smear or histopathologic findings from affected skin or an adjacent lymph node.
Scrofuloderma was present in 12 (80%) patients and solitary gumma in three (20%) patients. One case of scrofuloderma was associated with papulonecrotic tuberculid. Seven (46.6%) patients had pulmonary TB. Diagnosis was based on culture in nine patients (60%). The median CD4 cell count was 262 cells/µL. All patients were cured at the end of treatment (median time 6 months). Three patients presented with immune reconstitution inflammatory syndrome.
In this study, CTB associated with HIV infection presented as localised forms or in association with pulmonary TB. In patients with HIV who have subacute and chronic skin lesions, CTB should be considered in differential diagnosis, which may represent a good opportunity for early diagnosis of active TB.
皮肤结核（CTB）是一种罕见的肺外结核形式。尽管结核病和艾滋病病例有所增加，但皮肤结核的报告病例却很少。
描述结核病队列中HIV感染患者的皮肤结核病例。
我们基于2000年至2016年的二手数据描述了一系列15例皮肤结核合并HIV感染的病例。诊断基于结核分枝杆菌培养分离或对抗结核治疗的临床反应，同时伴有受累皮肤或相邻淋巴结涂片或组织病理学检查结果阳性。
12例（80%）患者出现瘰疬性皮肤结核，3例（20%）患者出现孤立性树胶肿。1例瘰疬性皮肤结核与丘疹坏死性结核疹相关。7例（46.6%）患者患有肺结核。9例（60%）患者的诊断基于培养结果。CD4细胞计数中位数为262个/微升。所有患者在治疗结束时（中位时间6个月）均治愈。3例患者出现免疫重建炎症综合征。
在本研究中，与HIV感染相关的皮肤结核表现为局限性形式或与肺结核相关。对于有亚急性和慢性皮肤病变的HIV患者，鉴别诊断时应考虑皮肤结核，这可能是早期诊断活动性结核的良好机会。
