Vita Serena, Mariano Andrea, Faraglia Francesca, Colombo Daniele, Scarabello Alessandra, Gualano Gina, Palazzolo Claudia, Villanacci Alberta, Olivieri Antonia Maria, Del Nonno Franca, Mirante Enrico, Ianniello Stefania, D'Abramo Alessandra, Nicastri Emanuele
National Institute for Infectious Diseases 'Lazzaro Spallanzani' Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Via Portuense, 292, 00149, Rome, Italy.
Emergency Department Sant'Eugenio Hospital, Rome, Italy.
Infect Dis Poverty. 2025 Nov 6;14(1):113. doi: 10.1186/s40249-025-01377-7.
Cutaneous tuberculosis (CTB) is an unusual manifestation of extrapulmonary tuberculosis, accounting for only 1.0%-1.5% of cases. It presents with a wide range of clinical morphologies, often mimicking other dermatoses such as fungal infections, leprosy, or sarcoidosis. Among its different variants, the ulcerative form is particularly rare and clinically deceptive. Reporting rare presentation is important to raise awareness among physicians, as early recognition and prompt treatment are essential to prevent complications such as scarring, contractures, or malignant transformation.
We report the case of a 24-year-old Malian male admitted to the National Institute for Infectious Diseases Lazzaro Spallanzani. The patient presented with a 4-month history of ulcerative skin lesions on the chest, neck, and left leg, accompanied by systemic symptoms including asthenia, cachexia, and generalized lymphadenopathy. Imaging revealed extensive bilateral psoas abscesses, vertebral involvement consistent with spondylodiscitis, and signs of empyema necessitans. Polymerase chain reaction (PCR) testing of drained abscess fluid confirmed Mycobacterium tuberculosis complex. Skin biopsy histology and PCR further supported the diagnosis of CTB. The patient was treated with standard anti-tuberculosis therapy (isoniazid, rifampicin, ethambutol, pyrazinamide) alongside broad-spectrum antibiotics. After 30 days, partial improvement of skin lesions was observed, although complete resolution was not achieved after 8 months of follow-up.
This case highlights the diagnostic challenge and chronicity of CTB, particularly in the ulcerative presentation. The patient developed disseminated tuberculosis with cutaneous involvement without any recent travel or known tuberculosis exposure, and the probable etiology is latent reactivation. There should be a high index of suspicion for CTB in patients presenting with indolent, atypical skin lesions, particularly those from an endemic region. Early diagnosis and prolonged therapy are crucial to avoid long-term sequelae.
皮肤结核（CTB）是肺外结核的一种不常见表现形式，仅占病例的1.0%-1.5%。它呈现出广泛的临床形态，常与其他皮肤病如真菌感染、麻风或结节病相似。在其不同变体中，溃疡性形式尤为罕见且在临床上具有欺骗性。报告罕见表现对于提高医生的认识很重要，因为早期识别和及时治疗对于预防诸如瘢痕形成、挛缩或恶性转化等并发症至关重要。
我们报告了一名24岁马里男性患者，他入住了拉扎罗·斯帕兰扎尼国家传染病研究所。患者有4个月的胸部、颈部和左腿溃疡性皮肤病变病史，并伴有全身症状，包括乏力、恶病质和全身淋巴结肿大。影像学检查显示双侧腰大肌广泛脓肿、与脊椎间盘炎一致的椎体受累以及脓胸的迹象。对引流的脓肿液进行聚合酶链反应（PCR）检测证实为结核分枝杆菌复合群。皮肤活检组织学和PCR进一步支持了皮肤结核的诊断。患者接受了标准抗结核治疗（异烟肼、利福平、乙胺丁醇、吡嗪酰胺）以及广谱抗生素治疗。30天后，观察到皮肤病变有部分改善，尽管在8个月的随访后未完全消退。
本病例突出了皮肤结核的诊断挑战和慢性病程，特别是在溃疡性表现中。患者在没有近期旅行或已知结核暴露史的情况下发生了播散性结核并累及皮肤，可能的病因是潜伏感染的重新激活。对于出现惰性、非典型皮肤病变的患者，尤其是来自流行地区的患者，应高度怀疑皮肤结核。早期诊断和长期治疗对于避免长期后遗症至关重要。
