Tuberculosis verrucosa cutis

Tuberculosis verrucosa cutis (TVC) is a form of cutaneous tuberculosis that occurs due to direct inoculation of Mycobacterium tuberculosis into the skin of a previously infected or sensitized individual. It is also known as warty tuberculosis or prosector's wart.

Clinical Presentation

Tuberculosis verrucosa cutis typically presents as a warty, verrucous lesion that is often found on the hands, feet, knees, or elbows. The lesion is usually solitary and may have a purplish or brownish color. Over time, the lesion can become hyperkeratotic and may develop fissures. The condition is generally painless but can be itchy.

Pathogenesis

The disease occurs when Mycobacterium tuberculosis is introduced into the skin through minor trauma or abrasions. This usually happens in individuals who have been previously sensitized to the bacterium, either through a previous infection or BCG vaccination. The immune response in these individuals leads to the formation of a localized, warty lesion.

Diagnosis

Diagnosis of Tuberculosis verrucosa cutis is based on clinical presentation, histopathological examination, and microbiological studies. A skin biopsy typically shows granulomatous inflammation with caseation necrosis. Ziehl-Neelsen stain may reveal acid-fast bacilli. Polymerase chain reaction (PCR) and culture of the lesion can also be used to identify Mycobacterium tuberculosis.

Treatment

The treatment of Tuberculosis verrucosa cutis involves the use of standard anti-tubercular therapy (ATT). The regimen usually includes a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol for the initial two months, followed by isoniazid and rifampicin for an additional four months. The duration and specific drugs may vary based on the patient's overall health and response to treatment.

Prognosis

With appropriate treatment, the prognosis for Tuberculosis verrucosa cutis is generally good. The lesions typically resolve with minimal scarring. However, untreated or inadequately treated cases can lead to chronic infection and complications.

Prevention

Preventive measures include proper wound care and hygiene, especially in individuals at risk of exposure to Mycobacterium tuberculosis. BCG vaccination may provide some level of protection against cutaneous forms of tuberculosis.

Epidemiology

Tuberculosis verrucosa cutis is more common in regions with high prevalence of tuberculosis. It is often seen in healthcare workers, laboratory personnel, and individuals with frequent exposure to infected materials.

See Also

• Cutaneous tuberculosis
• Mycobacterium tuberculosis
• BCG vaccine
• Granulomatous inflammation