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The significance of histopathologic patterns in positive tuberculin skin test site

Aptullah Haholu1, Faruk Ciftci, Ozlem Karabudak

  • 1Department of Pathology, Gulhane Medical Academy Haydarpasa Teaching Hospital, Uskudar, Istanbul, Turkey. haholu@yahoo.com

Journal of Cutaneous Pathology
|January 19, 2008
PubMed
Abstract

Insights

Histologic patterns at the tuberculin skin test site can indicate tuberculosis status. Erythema multiforme-type reactions and bulla formation are associated with active tuberculosis.

Area of Science:

  • Immunology
  • Dermatology
  • Infectious Diseases

Background:

  • The histological presentation of tuberculin skin test sites is variable.
  • This variability may correlate with the patient's tuberculosis status.

Purpose of the Study:

  • To investigate the relationship between tuberculin skin test (TST) reaction histology and tuberculosis activity.
  • To determine if specific histological patterns can differentiate between active and latent tuberculosis.

Main Methods:

  • Analysis of 48 purified protein derivative (PPD)-positive cases, with 30 having active tuberculosis.
  • Histological classification of TST reactions into Perivascular (PV)-type, Basal Spongiotic Dermatitis (BSD)-type, and Erythema Multiforme (EM)-type.
  • Statistical comparison of histological pattern frequencies in active versus latent tuberculosis groups.

Main Results:

  • Erythema Multiforme (EM)-type reactions were significantly more prevalent in the active tuberculosis group (56.7%) compared to the latent group (11.1%).
  • Perivascular (PV)-type reactions were more common in latent tuberculosis (50%) than in active tuberculosis (13.3%).
  • Bulla formation was observed in 7 subjects, all with active tuberculosis.

Conclusions:

  • The histological pattern of the PPD reaction site may serve as an indicator of tuberculosis activity (latent vs. active).
  • Bulla formation at the TST site is a significant indicator of active pulmonary tuberculosis.
  • Further immunohistopathologic studies are warranted to explore tuberculosis immunology through PPD reactions.

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