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Three cases of primary inoculation tuberculosis as a result of illegal acupuncture
Jin Ki Kim1, Tae Yoon Kim, Dong Hyun Kim
1Department of Dermatology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Abstract:
Primary inoculation tuberculosis results from the direct inoculation of Mycobacterium tuberculosis into the skin of a person who has no natural or artificially acquired immunity to the organism. The pathogenesis requires a break in the skin from an abrasion or injury that allows entry of the tubercle bacilli. We report 3 cases of primary inoculation tuberculosis resulting from illegal acupuncture. Three patients over 70 years old presented with erythematous, ulcerative, indurated plaques on the back. Skin lesions had developed at the acupuncture sites 1 or 2 weeks after a session of acupuncture, which was intended to relieve back pain. An unlicensed, non-medically trained person conducted each session. The patients' past medical and family histories were unremarkable. Granulomatous inflammatory infiltration and acid-fast bacilli were observed histologically. M. tuberculosis was identified by mycobacterial culture and polymerase chain reaction. Nine months after the initiation of antituberculosis medication, skin lesions improved, and no evidence of recurrence or other organ involvement was observed at the 1-year follow-up visit.
Insights
Primary inoculation tuberculosis can occur from illegal acupuncture, leading to skin lesions. Early antituberculosis medication effectively treated these cases, preventing recurrence.
Area of Science:
- Dermatology
- Infectious Diseases
- Public Health
Background:
- Primary inoculation tuberculosis (PIT) arises from direct Mycobacterium tuberculosis (M. tuberculosis) skin entry.
- PIT pathogenesis involves skin breaches, allowing tubercle bacilli to enter.
- This case series investigates PIT linked to unlicensed acupuncture.
Observation:
- Three elderly patients presented with skin lesions at acupuncture sites.
- Lesions appeared 1-2 weeks post-acupuncture, intended for back pain relief.
- Acupuncture was performed by unlicensed, non-medically trained individuals.
Findings:
- Histology revealed granulomatous inflammation and acid-fast bacilli.
- Mycobacterial culture and PCR confirmed M. tuberculosis.
- Skin lesions improved with antituberculosis medication within nine months.
Implications:
- Highlights the risk of PIT from unhygienic invasive procedures.
- Underscores the importance of licensed practitioners for acupuncture.
- Demonstrates effective treatment outcomes for PIT with timely medication.
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