A Case Report of a young Lady with Disseminated TB with Rare Skin Manifestation

Abstract

Tuberculosis (TB) poses an enormous global health challenge with high morbidity and mortality. The deadly synergy of HIV and tuberculosis and emergence of multidrug-resistance M. tuberculosis has transformed the pattern of presentation of tuberculosis from common lung involvement to extrapulmonary site. Dissemination of TB depends on the degree of immunosuppression and host factors. We evaluated 30 year old HIV positive lady that presented with disseminated tuberculosis involving the lungs, abdomen and cervical lymph node with extension to the skin. The skin involvement manifested as an extensive cutaneous ulcer in the left cervical region. Cyto-histopathologcal examination of the wound biopsy shows an ulcerated skin tissue composed of caseous-like necrosis, giant cell like and abundant mixed inflammatory cell infiltrate. Zielhl Neelson stain shows numerous tuberculous bacilli, with no evidence of malignancy. Chest radiograph showed features of consolidation, pleural effusion and milliary shadow evolving both lung fields. Abdominal ultra sound showed features of multiple para aortic lymph node enlargement and moderate ascites, her haemoglobin concentration was 6.0g/dl, CD4+T cell count 327 cells/ul. Hepatitis B surface antigen and hepatitis C virus antibody was negative. Liver and renal function tests were essentially within normal limit. Extensive ulcer in the cervical region could be due scrofuloderma especially in TB endemic region. Disseminated tuberculosis lesion and hypoalbuminaemia is associated with mortality. Facility and expertise required to manage common infectious diseases such as tuberculosis in Sub-Saharan Africa need to be upgraded.

Keywords: Cutaneous TB, HIV infection, Histopathology, TB drug induced Hepatitis