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Nodular tuberculid: a report of four patients
H F Jordaan1, J W Schneider, E A Abdulla
1Departments of Dermatology, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa.
Pediatric Dermatology
|July 8, 2000
Summary
Nodular tuberculid (NT) is a distinct hypersensitivity reaction to Mycobacterium tuberculosis (MTB), presenting as limb nodules. Early diagnosis and anti-tuberculosis treatment lead to complete resolution of skin and pulmonary lesions.
Area of Science:
- Dermatology
- Infectious Diseases
- Pathology
Background:
- Tuberculids are hypersensitivity reactions to Mycobacterium tuberculosis (MTB).
- Common forms include papulonecrotic tuberculid (PNT) and erythema induratum of Bazin (EIB).
- MTB is often undetectable by traditional staining or culture, but PCR can detect MTB DNA.
Observation:
- This study describes four pediatric and young adult female patients with nodular lesions on the limbs.
- Lesions were nontender, dull red/bluish-red nodules without ulceration.
- All patients had a positive Mantoux test, with two having associated pulmonary tuberculosis.
Findings:
- Histopathology revealed granulomatous inflammation (GI), vasculitis, and necrosis in the deep dermis and subcutaneous fat.
- Nodular tuberculid (NT) lesions showed GI (n=4), vasculitis (n=2), and necrosis (n=2).
- Ziehl-Neelsen (ZN) stain was negative in all cases, but PCR could potentially detect MTB DNA.
Implications:
- Nodular tuberculid (NT) is proposed as a distinct entity within cutaneous tuberculosis classifications.
- Distinguishing NT from other nodular lesions like erythema nodosum is crucial for appropriate management.
- Prompt diagnosis and a full 6-month course of anti-tuberculosis treatment resulted in complete resolution of both cutaneous and pulmonary manifestations.