Tuberculosis cutis colliquativa A18.4

Subcutaneous, postprimary, subacute form of tuberculosis leading to fusions and fistulas, with a normal but also hyperglycemic reaction of the organism. Mostly caused by the spread of organ tuberculosis close to the skin (e.g. in lymph nodes or bones) to the cutis and subcutis, more rarely exogenous.

The submandibular and supraclavicular region, inguinal region, retroauricular region and lateral parts of the neck are frequently affected.

Usually several spherically bulging, subcutaneous nodes covered by livid red skin. Later softening, perforation and fistulation or ulceration. Healing with the formation of funnel-shaped scars as well as bead, tip and bridge scars. Recurrent nodule eruptions.

Special form: Tuberculosis subcutanea et fistulosa.

The reliable diagnosis of tuberculosis is based on the isolation of Mycobacterium tuberculosis from puncture fluid and/or biopsy fragments or on histological examination of biopsies or surgical excision specimens. The use of the polymerase chain reaction technique can be very helpful and establish the diagnosis quickly so that tuberculosis treatment can be initiated at an early stage.

Gumma

Tularaemia

Cat scratch disease

Sporotrichosis

Hidradenitis suppurativa

Lymphogranuloma venereum

The treatment of tuberculosis cutis colliquativa is controversial. The combination of surgery and tuberculosis treatment is the only guarantee of a definitive cure and is preferentially recommended to reduce recurrences.

The classic drug treatment for tuberculosis consists of two months of quadruple tuberculosis therapy (isoniazid, rifampicin, ethambutol, and pyrazinamide), followed by dual therapy (isoniazid and rifampicin) for a total treatment period of nine to twelve months.

This drug treatment is preceded by surgical treatment in which the abscess is completely evacuated or even resected and the underlying necrotic tissue is removed. The prognosis is favorable in most cases, but depends on how quickly the diagnosis is made and treatment is initiated .

Children: Early surgical evacuation, search for and, if necessary, treatment of concurrent organ tuberculosis, search for the source of infection (milk).

Scrophuloderm: from the Latin scrofa=pig and the Greek derma=skin.

25-year-old Brazilian man who noticed an initially painless erythematous nodule in the right supraclavicular region 6 years ago. This had ulcerated after about 30 days and developed into a secretory fistula with persistence. Another similar nodule appeared three months later in the right infraclavicular region. A diagnosis of pyoderma gangraenosum was made. Treatment with prednisone and dapsone was unsuccessful.

After four months, more nodules and fistulas appeared in the axillae, left supraclavicular region, and right parasternal region, with persistent purulent secretion. Now the diagnosis of hidradenitis suppurativa was made. Therapy was with antiseptics and an oral tetracycline. This also without improvement.

Finally, a fluctuant, erythematous tumor mass without local warmth developed with a size of about 4 cm x 3 cm in the left neck region. The patient had no chronic cough, weight loss, fever, or other complaints. Supplementary examinations revealed no abnormalities in the anterior and lateral chest radiographs. Microbiologically, Mycobacterium tuberculosis was diagnosed. Treatment was rifampicin, isoniazid, pyrazinamide, and ethambutol after surgical sanitation.

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