<b>Introduction</b>: Disseminated tuberculosis (TB) may occur with skin and ocular involvement which are not common manifestations in children and may lead to debilitating complications. <b>Objective...<b>Introduction</b>: Disseminated tuberculosis (TB) may occur with skin and ocular involvement which are not common manifestations in children and may lead to debilitating complications. <b>Objective</b>: A child with multi-organ TB involving the lungs, chest abdomen, skin and eyes who had been symptomatic for 3 years is reported. <b>Case Report</b>: A 6-year-old girl presented with recurrent fever, abdominal pain and weight loss of 3 years and skin lesions of a year duration. There was history of pain and redness of the eyes associated with discharge. She was not vaccinated at all. She was chronically ill-looking with bilateral conjunctival hyperaemia, purulent eye discharge with corneal opacity of the right eye. She had significant lymphadenopathy, digital clubbing and ulcerated, discharging swellings around her neck and axilla (scrofuloderma). She had reduced breath sounds and coarse crepitations. Hepatosplenomegaly and ascites were present. She later developed bulging of the upper part of the cornea of the right eye which was diagnosed by the ophthalmologist to be cornea ulcer with anterior staphyloma. <b>Results, Treatment and Outcome</b>: Complete blood count (leucocytosis 12,800 cells), erythrocyte sedimentation rate (150 mm/hr) and tuberculin test (7 mm induration) were suggestive of TB. Radiological tests were also supportive. She received anti-Kochs in addition to systemic and ocular antibiotics. Skin lesions healed progressively and stopped discharging. Caregivers were counseled on poor visual prognosis of the right eye. She was discharged but lost to follow up. <b>Conclusion</b>: Multi-organ involvement of TB especially ocular and cutaneous TB is not common but is very debilitating. More preventive efforts with vaccination and expertise are needed at lower levels of health care in the community to aid early diagnosis.展开更多
We report this case of a 15-year-old male who presented to the children outpatient clinic (CHOP) of Abia State University Teaching Hospital (ABSUTH), Aba on the 5th of November 2015. He had tuberculosis (TB) of the sk...We report this case of a 15-year-old male who presented to the children outpatient clinic (CHOP) of Abia State University Teaching Hospital (ABSUTH), Aba on the 5th of November 2015. He had tuberculosis (TB) of the skin (scrofuloderma) which was not diagnosed and had received treatment other than anti-TB medication. He now presented 9 years after with multiple body discharging sinuses, cicatricial skin lesions, tuberculosis of the spine (L5, S1) with contracture of the Achilles Tendon and genital warts. Subsequent treatment with full anti-TB drugs led to resolution of his illness. A higher index of suspicion is required for early diagnosis of extrapulmonary TB. Prompt and adequate treatment with anti-TB medication ensures cure in such cases. Appropriate control program is also known to improve the outcome and reduce sequelae.展开更多
Introduction:Scrofuloderma is caused by Mycobacterium tuberculosis and is the most common form of cutaneous tuberculosis.It remains a significant medical challenge because its clinical manifestations mimic those of va...Introduction:Scrofuloderma is caused by Mycobacterium tuberculosis and is the most common form of cutaneous tuberculosis.It remains a significant medical challenge because its clinical manifestations mimic those of various other conditions,making diagnosis difficult.Here,we report a 28-year-old man who had been diagnosed with intestinal tuberculosis but discontinued treatment.Case presentation:He subsequently presented with a 5-month history of multiple non-healing ulcerative lesions on the abdomen with no other significant clinical findings.Ziehl-Neelsen staining of an impression smear taken from the lesions was performed as the preliminary investigation and confirmed the presence of acid-fast bacilli.Histopathologic examination of a skin biopsy specimen,PCR,and the Mantoux test also confirmed the presence of Mycobacterium tuberculosis.The patient began treatment with anti-tubercular drugs and his lesions gradually regressed.Discussion:The most common finding of scrofuloderma is a chronic,painless ulcerative lesion with purulent discharge.Cervical lymph nodes are frequently involved.These clinical features mimic several other bacterial and fungal conditions.However,Ziehl-Neelsen staining of the discharging ulcers can be used as a preliminary test to demonstrate acid fast bacilli in most of the cases.Histopathologic examination of skin biopsy specimen,culture on LowensteinJensen media and PCR can confirm the diagnosis.Conclusion:Although Scrofuloderma is a rare cutaneous manifestation,it is curable with early diagnosis and prompt intervention of antitubercular drugs.展开更多
文摘<b>Introduction</b>: Disseminated tuberculosis (TB) may occur with skin and ocular involvement which are not common manifestations in children and may lead to debilitating complications. <b>Objective</b>: A child with multi-organ TB involving the lungs, chest abdomen, skin and eyes who had been symptomatic for 3 years is reported. <b>Case Report</b>: A 6-year-old girl presented with recurrent fever, abdominal pain and weight loss of 3 years and skin lesions of a year duration. There was history of pain and redness of the eyes associated with discharge. She was not vaccinated at all. She was chronically ill-looking with bilateral conjunctival hyperaemia, purulent eye discharge with corneal opacity of the right eye. She had significant lymphadenopathy, digital clubbing and ulcerated, discharging swellings around her neck and axilla (scrofuloderma). She had reduced breath sounds and coarse crepitations. Hepatosplenomegaly and ascites were present. She later developed bulging of the upper part of the cornea of the right eye which was diagnosed by the ophthalmologist to be cornea ulcer with anterior staphyloma. <b>Results, Treatment and Outcome</b>: Complete blood count (leucocytosis 12,800 cells), erythrocyte sedimentation rate (150 mm/hr) and tuberculin test (7 mm induration) were suggestive of TB. Radiological tests were also supportive. She received anti-Kochs in addition to systemic and ocular antibiotics. Skin lesions healed progressively and stopped discharging. Caregivers were counseled on poor visual prognosis of the right eye. She was discharged but lost to follow up. <b>Conclusion</b>: Multi-organ involvement of TB especially ocular and cutaneous TB is not common but is very debilitating. More preventive efforts with vaccination and expertise are needed at lower levels of health care in the community to aid early diagnosis.
文摘We report this case of a 15-year-old male who presented to the children outpatient clinic (CHOP) of Abia State University Teaching Hospital (ABSUTH), Aba on the 5th of November 2015. He had tuberculosis (TB) of the skin (scrofuloderma) which was not diagnosed and had received treatment other than anti-TB medication. He now presented 9 years after with multiple body discharging sinuses, cicatricial skin lesions, tuberculosis of the spine (L5, S1) with contracture of the Achilles Tendon and genital warts. Subsequent treatment with full anti-TB drugs led to resolution of his illness. A higher index of suspicion is required for early diagnosis of extrapulmonary TB. Prompt and adequate treatment with anti-TB medication ensures cure in such cases. Appropriate control program is also known to improve the outcome and reduce sequelae.
文摘Introduction:Scrofuloderma is caused by Mycobacterium tuberculosis and is the most common form of cutaneous tuberculosis.It remains a significant medical challenge because its clinical manifestations mimic those of various other conditions,making diagnosis difficult.Here,we report a 28-year-old man who had been diagnosed with intestinal tuberculosis but discontinued treatment.Case presentation:He subsequently presented with a 5-month history of multiple non-healing ulcerative lesions on the abdomen with no other significant clinical findings.Ziehl-Neelsen staining of an impression smear taken from the lesions was performed as the preliminary investigation and confirmed the presence of acid-fast bacilli.Histopathologic examination of a skin biopsy specimen,PCR,and the Mantoux test also confirmed the presence of Mycobacterium tuberculosis.The patient began treatment with anti-tubercular drugs and his lesions gradually regressed.Discussion:The most common finding of scrofuloderma is a chronic,painless ulcerative lesion with purulent discharge.Cervical lymph nodes are frequently involved.These clinical features mimic several other bacterial and fungal conditions.However,Ziehl-Neelsen staining of the discharging ulcers can be used as a preliminary test to demonstrate acid fast bacilli in most of the cases.Histopathologic examination of skin biopsy specimen,culture on LowensteinJensen media and PCR can confirm the diagnosis.Conclusion:Although Scrofuloderma is a rare cutaneous manifestation,it is curable with early diagnosis and prompt intervention of antitubercular drugs.
