Tuberculous gumma

A rare form of cutaneous tuberculosis

Tuberculous Gumma

Tuberculous gumma on the skin

Tuberculous gumma, also known as metastatic tuberculous abscess, is a rare form of cutaneous tuberculosis. It is characterized by the formation of soft, tumor-like masses on the skin, which are caused by the hematogenous spread of Mycobacterium tuberculosis from a primary focus elsewhere in the body.

Pathophysiology

Tuberculous gumma occurs when Mycobacterium tuberculosis bacteria spread through the bloodstream and form abscesses in the skin. This condition is more likely to occur in individuals with a compromised immune system, such as those with HIV/AIDS or those undergoing immunosuppressive therapy. The bacteria can form nodules that eventually ulcerate, leading to the characteristic lesions of tuberculous gumma.

Clinical Presentation

Patients with tuberculous gumma typically present with painless, firm nodules on the skin. These nodules can vary in size and may become ulcerated over time. The lesions are often found on the extremities, but can occur anywhere on the body. The skin overlying the nodules may appear normal or erythematous.

Diagnosis

The diagnosis of tuberculous gumma is confirmed through a combination of clinical examination, skin biopsy, and microbiological studies. A biopsy of the lesion typically shows caseating granulomas, which are indicative of tuberculosis. Polymerase chain reaction (PCR) and culture of the biopsy material can be used to identify Mycobacterium tuberculosis.

Treatment

The treatment of tuberculous gumma involves the use of antitubercular therapy. The standard regimen includes a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide for an initial period, followed by isoniazid and rifampicin for a continuation phase. The duration of treatment is typically 6 to 12 months, depending on the severity of the disease and the patient's response to therapy.

Prognosis

With appropriate treatment, the prognosis for patients with tuberculous gumma is generally good. The lesions usually resolve with antitubercular therapy, although scarring may occur. Early diagnosis and treatment are crucial to prevent complications and the spread of the disease.

Related Pages

• Tuberculosis
• Cutaneous tuberculosis
• Mycobacterium tuberculosis
• Granuloma