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Lymphatic spread in an immunocompetent adult.
Med Sante Trop. 2019 May 01; 29(2):139-141.MS

Abstract

Cutaneous tuberculosis with lymphatic spread is rarely described. We report the case of a woman aged 38, immunocompetent, working in a fruit sorting center, who consulted us for ulceration of the left third finger that had persisted for four months, following a prick from a prickly pear. Physical examination revealed a nodular, erythematous, and ulcerative lesion of the left third finger, associated with inflammatory subcutaneous nodules arranged in a line along the ipsilateral upper extremity and an ipsilateral axillary lymph node. Laboratory tests and chest X-ray were normal. Pathological examination revealed granulomatous chronic inflammation without necrosis. PCR detected DNA from Mycobacterium tuberculosis. No extracutaneous tuberculosis locations were detected. A tuberculous chancre by direct inoculation was therefore diagnosed. The patient received quadruple therapy (rifampicin + isoniazid + pyrazinamide + ethambutol) for 2 months, followed by a combination therapy based on isoniazid and rifampicin for 6 months. Marked regression of the cutaneous lesions occurred after 1 month of first-line therapy. A tuberculous chancre is a rare form of cutaneous tuberculosis, with possible lymphatic spread, in immunocompromised patients but also in immunocompetent children and young adults.

Authors+Show Affiliations

Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.Hôpital universitaire Farhat Hached, Sousse, Tunisie.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

31379337

Citation

Ghariani Fetoui, N, et al. "Lymphatic Spread in an Immunocompetent Adult." Medecine Et Sante Tropicales, vol. 29, no. 2, 2019, pp. 139-141.
Ghariani Fetoui N, Aounallah A, Boussofara L, et al. Lymphatic spread in an immunocompetent adult. Med Sante Trop. 2019;29(2):139-141.
Ghariani Fetoui, N., Aounallah, A., Boussofara, L., Ben Kahla, M., Mokni, S., Marzouk, M., Gammoudi, R., Saidi, W., Boukadida, J., Sriha, B., Belajouza, C., Denguezli, M., Ghariani, N., & Nouira, R. (2019). Lymphatic spread in an immunocompetent adult. Medecine Et Sante Tropicales, 29(2), 139-141. https://doi.org/10.1684/mst.2019.0890
Ghariani Fetoui N, et al. Lymphatic Spread in an Immunocompetent Adult. Med Sante Trop. 2019 May 1;29(2):139-141. PubMed PMID: 31379337.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lymphatic spread in an immunocompetent adult. AU - Ghariani Fetoui,N, AU - Aounallah,A, AU - Boussofara,L, AU - Ben Kahla,M, AU - Mokni,S, AU - Marzouk,M, AU - Gammoudi,R, AU - Saidi,W, AU - Boukadida,J, AU - Sriha,B, AU - Belajouza,C, AU - Denguezli,M, AU - Ghariani,N, AU - Nouira,R, PY - 2019/8/6/entrez PY - 2019/8/6/pubmed PY - 2020/2/28/medline KW - Tunisia KW - cutaneous tuberculosis KW - granulomatous inflammation KW - lymphangitic spread SP - 139 EP - 141 JF - Medecine et sante tropicales JO - Med Sante Trop VL - 29 IS - 2 N2 - Cutaneous tuberculosis with lymphatic spread is rarely described. We report the case of a woman aged 38, immunocompetent, working in a fruit sorting center, who consulted us for ulceration of the left third finger that had persisted for four months, following a prick from a prickly pear. Physical examination revealed a nodular, erythematous, and ulcerative lesion of the left third finger, associated with inflammatory subcutaneous nodules arranged in a line along the ipsilateral upper extremity and an ipsilateral axillary lymph node. Laboratory tests and chest X-ray were normal. Pathological examination revealed granulomatous chronic inflammation without necrosis. PCR detected DNA from Mycobacterium tuberculosis. No extracutaneous tuberculosis locations were detected. A tuberculous chancre by direct inoculation was therefore diagnosed. The patient received quadruple therapy (rifampicin + isoniazid + pyrazinamide + ethambutol) for 2 months, followed by a combination therapy based on isoniazid and rifampicin for 6 months. Marked regression of the cutaneous lesions occurred after 1 month of first-line therapy. A tuberculous chancre is a rare form of cutaneous tuberculosis, with possible lymphatic spread, in immunocompromised patients but also in immunocompetent children and young adults. SN - 2261-2211 UR - https://www.unboundmedicine.com/medline/citation/31379337/Lymphatic_spread_in_an_immunocompetent_adult L2 - http://www.jle.com/medline.md?issn=2261-3684&vol=29&iss=2&page=139 DB - PRIME DP - Unbound Medicine ER -