Case Report

Cutaneous tuberculosis in HIV-infected individuals: Lessons learnt from a case series

Vhudzani Tshisevhe, Nontombi Mbelle, Remco P.H. Peters
Southern African Journal of HIV Medicine | Vol 20, No 1 | a895 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.895 | © 2019 Vhudzani Tshisevhe, Nontombi Mbelle, Remco P.H. Peters | This work is licensed under CC Attribution 4.0
Submitted: 03 August 2018 | Published: 12 March 2019

About the author(s)

Vhudzani Tshisevhe, Lancet Laboratories, Rustenburg, South Africa; and, Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Nontombi Mbelle, Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
Remco P.H. Peters, Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Department of Medical Microbiology, School for Public Health and Primary Care, University of Maastricht, Maastricht, the Netherlands; and, Anova Health Institute, Johannesburg, South Africa


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Abstract

Introduction: Extrapulmonary tuberculosis (TB) causes a significant burden of disease worldwide, especially among HIV-infected individuals and those with other immunosuppressive conditions. Cutaneous TB is an important manifestation of extrapulmonary TB but is uncommonly reported in South Africa despite the high burden of HIV and TB co-infection. There is a paucity of published data on clinical presentation and outcome of cutaneous TB in this context. Raising awareness of this condition among clinicians is imperative to improve early diagnosis and optimise treatment outcomes.

Patient presentation: In this series, we present three cases of cutaneous TB, two adults and one child, referred to a tertiary hospital from two primary healthcare centres and from a general practitioner. We demonstrate that the clinical presentation is diverse, ranging from papular lesions to abscesses, and that concordant pulmonary TB may be present.

Management: In particular, we show the importance of performing diagnostic procedures (e.g. aspiration) in individuals presenting with an abscess that does not respond to broad spectrum antimicrobial treatment, particularly in those with advanced immunosuppression.

Outcome and conclusion: The outcome of our three patients was poor, highlighting the need for earlier diagnosis in this WHO Stage 4 condition and intensive management of clinical cases.

Keywords: HIV-medicine; Retro-Viral Disease; Mycobacteria; Tuberculosis; Multidrug Resistance; Cutaneous Tuberculosis; Cutaneous Disease; immunocompromised.


Keywords

Medicine; HIV Medicine; Retro-viral Disease; Mycobacteria; Tuberculosis; TB; Multi-drug Resistance; Cutaneous Tuberculosis; Cutaneous Disease; Immunocompromised

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