Tuberculosis cutis colliquativa due to tuberculous dactylitis in an adult
Tuberculosis cutis colliquativa due to tuberculous dactylitis in an adult
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DOI：
10.1111/ddg.13721
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发表时间：
2018-12
期刊：
影响因子：
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通讯作者：
Mami Fujii;Atsuko Harimoto;T. Namiki;N. Ishii
中科院分区：
文献类型：
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作者：
Mami Fujii;Atsuko Harimoto;T. Namiki;N. Ishii
液化性皮肤结核病（硬皮病）是一种内源性皮肤结核病，从淋巴结、骨、关节或附睾延伸至皮肤[1]。液化性皮肤结核最常见的部位是颈部，它从下面的淋巴结扩散[2]。由结核性指（趾）炎（一种累及手或足小骨的肺外结核）引起的手指液化性皮肤结核极为罕见;只有两例免疫功能正常的儿童报告[3，4]。在这里，我们报告了第一例健康成人结核性指炎上的液化性皮肤结核病例。一名77岁的健康男性因左手小指上有一年无痛性增大结节和斑块病史而转诊。在他来我们医院之前，他自己治疗了一年的伤口。由于结节和斑块扩大，他去了家庭诊所，并被转介到我院进行进一步评估。患者无结核病既往史或家族史。体格检查显示掌指关节附近有一个8 mm x 6 mm的溃疡性坏死结节，左手小指尺侧近端指间关节附近有一个2 mm x 2 mm的斑块（图1 a）。怀疑鳞状细胞癌和细菌感染，并进行了活检。组织学检查结果显示真皮坏死和脓肿形成，但没有非典型细胞的证据。从积液中培养出金黄色葡萄球菌。实验室检查结果正常。虽然硫酸庆大霉素软膏已使用1个月，但两处病变均发生进展（图1 B），在他的小指桡侧出现一个新的4 mm x 5 mm的溃疡性结节（图1 c）。腋窝淋巴结肿大未触及。胸部X光片正常。上肢计算机断层扫描显示小指桡侧近节指骨部分缺失，骨至表皮有浸润性肿块（图1d）。我们怀疑是液化性皮肤结核、孢子丝菌病或非结核性分支杆菌
Tuberculosis cutis colliquativa (scrofuloderma) is an endogenous form of cutaneous tuberculosis that extends from a lymph node, bone, joint or epididymis to the skin [1]. The most frequent site of tuberculosis cutis colliquativa is the neck, where it spreads from underlying lymph nodes [2]. Tuberculosis cutis colliquativa of the fingers due to tuberculous dactylitis (a form of extrapulmonary tuberculosis involving the small bones of the hand or foot) is extremely rare; only two cases have been reported in immunocompetent children [3, 4]. Here we report the first case of tuberculosis cutis colliquativa overlying tuberculous dactylitis in a healthy adult.A 77-year-old healthy man was referred with a one-year history of a painless enlarging nodule and a plaque on his left little finger. Before he visited our hospital, he treated the wound himself for a year. Since the nodule and plaque enlarged, he visited a family clinic and was referred to our hospital for further evaluation. The patient had no past history or family history of tuberculosis. Physical examination revealed an 8 mm x 6 mm ulcerative necrotic nodule near the metacarpophalangeal joint and a 2 mm x 2 mm erythematous plaque near the proximal interphalangeal joint on the ulnar side of his left little finger (Figure 1 a). Squamous cell carcinoma and bacterial infection were suspected and a biopsy was performed. Histopathological findings showed necrosis and abscess formation in the dermis but no evidence of atypical cells. Staphylococcus aureus was cultured from the effusion. The results of laboratory examination were normal. Although gentamicin sulfate ointment was applied for a month, both lesions had progressed (Figure 1 b), and a new 4 mm x 5 mm erythematous ulcerative nodule appeared on the radial side of his little finger (Figure 1 c). Axillary lymphadenopathy was not palpable. The chest X-ray was normal. Computed tomography of the upper limb revealed loss of part of the proximal phalanx on the radial aspect of the little finger and an invasive mass from the bone to the epidermis (Figure 1 d). We suspected tuberculosis cutis colliquativa, sporotrichosis or non-tuberculous mycobacterial