Post Graduation of Clinical Research on Infectious Diseases, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Laboratory of Clinical Research in Mycobacteriosis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Int J Dermatol. 2019 Dec;58(12):1451-1459. doi: 10.1111/ijd.14617. Epub 2019 Sep 25.
Brazil is one of the highest tuberculosis (TB) burden countries of the world. Cutaneous tuberculosis (CTB) is a rare form of extrapulmonary manifestation of tuberculosis. This study aimed to describe the clinico-evolutive, laboratory and therapeutic aspects of CTB cases among patients from a cohort with TB in Rio de Janeiro, Brazil.
Cases of diagnosed CTB with microbiologic confirmation or clinical response to anti-tuberculous treatment associated with positive smear or histopathological findings between the years 2000 and 2016 were selected.
Seventy-five patients with CTB were included, most were women (58.7%) with a median age of 42 years. CTB diagnosis was based on culture in only 42.7% of the cases. Scrofuloderma represented 50.7% of the cases, followed by erythema induratum of Bazin (EIB) (18.7%), tuberculous gumma (13.3%), lupus vulgaris (8%), TB verrucosa cutis (4%), orificial TB (2.7%) and associated forms (2.7%). Other TB presentations were pulmonary (22.7%), mammary (6.6%) and osteoarticular (4%). All patients who completed the treatment (97.3%) had their lesions healed. Only two patients (2.6%) needed to change the therapy due to adverse reactions. Fifty percent of EIB patients presented recurrence.
These data highlight the diversity of CTB presentations and the importance of the skin to assist in early identification and treatment of TB. More studies are necessary to improve the knowledge on EIB for a better approach towards these patients, mainly in cases of recurrence.
巴西是世界上结核病（TB）负担最重的国家之一。皮肤结核（CTB）是一种罕见的肺外结核表现形式。本研究旨在描述巴西里约热内卢一个结核病队列患者中 CTB 病例的临床-演变、实验室和治疗方面。
选择了 2000 年至 2016 年间经微生物学证实或对与阳性涂片或组织病理学发现相关的抗结核治疗有临床反应的确诊 CTB 病例。
共纳入 75 例 CTB 患者，大多数为女性（58.7%），中位年龄为 42 岁。CTB 诊断仅基于培养的病例占 42.7%。类丹毒样皮肤结核（scrofuloderma）占 50.7%，紧随其后的是硬结性红斑（erythema induratum of Bazin，EIB）（18.7%）、结核性树胶肿（tuberculous gumma，13.3%）、寻常狼疮（lupus vulgaris，8%）、疣状皮肤结核（TB verrucosa cutis，4%）、溃疡性皮肤结核（orificial TB，2.7%）和混合性结核（2.7%）。其他结核表现为肺部（22.7%）、乳腺（6.6%）和骨关节炎（4%）。所有完成治疗的患者（97.3%）病变均愈合。仅有 2 例（2.6%）患者因不良反应需要改变治疗方案。50%的 EIB 患者出现复发。
这些数据突出了 CTB 表现的多样性，以及皮肤在早期识别和治疗结核病方面的重要性。需要进一步研究以提高对 EIB 的认识，以便更好地治疗这些患者，特别是在复发的情况下。
