Successful complex treatment of tuberculous lupus of the skin on the face

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Abstract

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, characterized by pronounced clinical heterogeneity and the development of a specific inflammatory reaction in the organs and tissues of the human body. Tuberculosis of the skin can be acquired as a result of direct contact, as well as lymphohematogenous or hematogenous genesis from another focus. Among all localizations of extrapulmonary tuberculosis, skin lesions occupy the fifth place, behind to tuberculosis of bones and joints, lymph nodes, genitourinary and digestive systems.

The increasing growth of tuberculosis among the population of the Russian Federation determines the relevance of timely correct diagnosis. The difficulties in diagnosing this disease are predetermined by the fact that atypical manifestations often occur, as well as the fact that clear histological and morphological signs of tuberculosis of the skin are not always noted.

The article presents epidemiological data on the incidence of tuberculosis of the skin and the classification used in practical medicine. Modern methods of diagnosing the disease are described.

The relevance of the clinical case presented in this article is due to the difficulties of diagnosis and low awareness of specialists. Thus, being under the supervision of a dermatovenerologist with a false diagnosis for 7 years, the patient achieved clinical remission after 8 months of specific therapy thanks to the joint work of a dermatovenereologist and a phthisiatrician.

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About the authors

Natalia P. Teplyuk

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: teplyukn@gmail.com
ORCID iD: 0000-0002-5800-4800
SPIN-code: 8013-3256

MD, Dr. Sci. (Medicine), Professor

Russian Federation, 4/1 Bolshaya Pirogovskaya st, Moscow, 119435

Olga V. Grabovskaya

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: olgadoctor2013@yandex.ru
ORCID iD: 0000-0002-5259-7481
SPIN-code: 1843-1090

MD, Dr. Sci. (Medicine), Professor

Russian Federation, 4/1 Bolshaya Pirogovskaya st, Moscow, 119435

Vladimir A. Varshavsky

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: vavarsh@gmail.com
ORCID iD: 0000-0002-5855-3092

MD, Dr. Sci. (Medicine), Professor

Russian Federation, 4/1 Bolshaya Pirogovskaya st, Moscow, 119435

Sofia V. Alferova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: sofia.alferova@mail.ru
ORCID iD: 0009-0000-5000-8359
SPIN-code: 1987-3444
Russian Federation, 4/1 Bolshaya Pirogovskaya st, Moscow, 119435

Inna A. Kurguzkina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: i.kurguzkina13@gmail.com
ORCID iD: 0009-0002-0649-7129
Russian Federation, 4/1 Bolshaya Pirogovskaya st, Moscow, 119435

References

  1. Kushtan IV, Grabovskaya OV, Teplyuk NP, et al. The combination of lichenoidic and colliquative tuberculosis of the skin (scrofuloderma). Russkii meditsinskii zhurnal. 2016;24(14):954–957. (In Russ.) EDN: WWXQKV
  2. Dias MF, Bernardes Filho F, Quaresma MV, et al. Update on cutaneous tuberculosis [published correction appears in An Bras Dermatol. 2015;90(1):143. doi: 10.1590/abd1806-4841.20142998e]. An Bras Dermatol. 2014;89(6):925–938. doi: 10.1590/abd1806-4841.20142998
  3. Santos JB, Figueiredo AR, Ferraz CE, et al. Cutaneous tuberculosis: Epidemiologic, etiopathogenic and clinical aspects, part I. An Bras Dermatol. 2014;89(2):219–228. doi: 10.1590/abd1806-4841.20142334
  4. Sharova NМ, Danilova АА, Habibulina МR, et al. The problem of diagnosing skin tuberculosis in clinical practice. Lechebnoe delo. 2024;(1):106–110. EDN: BOCIPG doi: 10.24412/2071-5315-2024-13093
  5. Mazurik EN, Zhaksilikova DB. Tuberculosis skin disease. Young scientist. 2019;(18):155–158. (In Russ.) EDN: ILVMZV
  6. Chen Q, Chen W, Hao F. Cutaneous tuberculosis: A great imitator. Clin Dermatol. 2019;37(3):192–199. doi: 10.1016/j.clindermatol.2019.01.008
  7. Kabulbekova АА, Ospanova SА, Omar АU, Sizdikova ZhА. Tuberculosis of skin: Diagnostic problems. Vestnik Kazahskogo nacionalʹnogo medicinskogo universiteta = Bulletin of the Kazakh National Medical University. 2012;(1):51–53. (In Russ.) EDN: YXWFZJ
  8. Zaslavskiy DV, Egorova YS, Chuprov IN, et al. Disseminated cutaneous tuberculosis. Vestnik dermatologii i venerologii. 2018;94(2):69–77. EDN: XSJXXF doi: 10.25208/0042-4609-2018-94-2-69-77

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Tuberculous lupus: the rash is represented by red-brown plaques up to 10 cm, rising above the skin level, of a soft consistency.

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3. Fig. 2. Histological examination: a skin fragment covered with stratified squamous epithelium with areas of hyperkeratosis. In the dermis and underlying tissues there are numerous macrophage-epithelioid granulomas with Pirogov-Langhans cells and multinuclear foreign body-type granulomas. Granulomas are single, as well as closely located, but not merging, without leukocytes and necrosis in the center.

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4. Fig. 3. Multispiral computed tomography: small subpleural calcification in S2 of the right lung and a small relatively dense lesion (3 mm in diameter) with relatively clear contours in the fibrous bands at the bifurcation level in S2 of the right lung. Single small star-shaped subpleural dense lesions with clear contours in the lungs.

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5. Fig. 4. Dynamics of the skin process against the background of specific therapy.

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