Atypical presentations of mucocutaneous TB in HIV: A case series from South Africa

Tuberculosis (TB) remains a major burden of disease worldwide, especially in Human immunodeficiency virus (HIV)-infected patients. Cutaneous forms of TB account for approximately 10 % of all extrapulmonary tuberculosis cases, with oral manifestations accounting for less than 1 % of these cases. A high index of suspicion is essential when diagnosing rare clinical presentations. The response to treatment is excellent in most patients, particularly those receiving concomitant, effective antiretroviral (ARV) treatment.

We report two cases of lupus vulgaris in AIDS patients (CD4 count of 113 cells/mm³ and 172 cells/mm³, respectively) and one case of mucosal TB in a patient with CD4 count of 365 cells/mm³. All the patients were adults referred to the dermatology clinic. The atypical clinical presentations included papules, plaques, and ulcers affecting unusual sites, such as the upper and lower limbs in the case of lupus vulgaris and a tongue ulcer in the patient with oral TB, emphasizing the importance of strong suspicion in HIV-infected patients. All available diagnostic measures were used to confirm the diagnosis.

We demonstrate the importance of multidisciplinary care for patients and an excellent response to anti-TB treatment once diagnosed. We also emphasize the importance of concomitant ARV treatment and patient follow-up.

The outcomes of two of the three patients were good, highlighting the importance of timely clinical diagnosis and treatment, including monitoring and follow-up, while ensuring continued ARV treatment.