Calado Juliana de Oliveira Alves, Miola Anna Carolina, Silvares Maria Regina Cavariani, Marques Silvio Alencar
Department of Dermatology and Radiotherapy, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil.
Department of Dermatology and Radiotherapy, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil.
An Bras Dermatol. 2020 May-Jun;95(3):343-346. doi: 10.1016/j.abd.2019.08.031. Epub 2020 Mar 20.
Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.
皮肤结核是结核病一种罕见的肺外表现,与播散性结核病一样,通常发生在免疫功能低下的患者中。蓬塞特反应性关节炎是一种影响肺外结核患者的血清阴性关节炎,即使在结核病流行国家也不常见。我们报告了一名既往健康的23岁男性患者,他出现水样腹泻,伴有下肢红斑性溃疡和手部少关节炎。皮肤组织病理学检查显示上皮样肉芽肿形成,伴有栅栏状肉芽肿和中央干酪样坏死。经齐-尼氏染色进行抗酸杆菌筛查显示有完整的杆菌,结核分枝杆菌培养呈阳性,结肠镜检查发现多处浅溃疡。诊断为播散性结核病合并反应性蓬塞特关节炎,经适当治疗后临床和皮肤状况有所改善。