Summary Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg-Strauss Syndrome (CSS) is a rare granulomatous necrotizing vasculitic disease characterized by the presence of asthma, sinusitis, and hypereosinophilia. We describe a patient who was initially diagnosed with tuberculous lymphadenitis and later diagnosed with EGPA.
Granulomatosis with Polyangiitis ; Tuberculosis, Cutaneous ; Tuberculosis, Lymph Node

A clinical and histopathologic study was done on 48 cases of cutaneous tuberculosis among 43, 209 out-patients in Dermatologic department of Korea t.Jniversity Hospital during the period of 15 years and 9 mont4s from January, 1969 to September, 1984. These 48 cases were consistent with skin tuberculosis in histologic and clinicalI finc1ings, The result were summarized as follows: ]. The incidence of skin tuberculosis was 0 I 1 g among 43, 209 cases of outpatients. 2. Localized type of skin tuberculosis was 3. 2 times more frequent than disseminated type. Frequent skin tuberculosis was lupus vulgaris (57 3%), erythema induratum (12, 5%), tuberculosis verrucosa cutis(8.3%) and lupus milaris disseminatus faciei (8. 3%). 4, The ratio between male and fenmle was 1: l. 1. 5 The ages of onset were variable according to the types of skin tuberculosis. but 45 8% of all cases developed in the age group between 10 and 29 years. Seasonal incidences of skin tuberculosis were 52. 1% in spring, 85%, in winter, 18. 8% in summer, 4, 2%, in autumn. 7 In histopathologic findings, there were tubercle or tubrculoid structures in all cases and typical tubercle structures were observed in 18.8% The ratio of accordance between the histopathologic diagnosis and clinicopa thologic diagnosis was 81.3%.
Diagnosis ; Erythema Induratum ; Humans ; Incidence ; Korea ; Lupus Vulgaris ; Male ; Outpatients ; Seasons ; Skin* ; Tuberculosis ; Tuberculosis, Cutaneous*

Cutaneous tuberculids are relatively rare hypersensitivity reactions to Mycobacterium tuberculosis, characterized by erythematous eruption on the skin of a tuberculosis patient. Papulonecrotic tuberculid, lichen scrofulosorum, erythema induratum and nodular tuberculid were originally included in tuberculids. However, some cases are difficult to classify into the subtypes because of their broad spectrum of cutaneous manifestations and various histopathologies. This is particularly true in immunocompromised patients. We report a case of atypical cutaneous tuberculid in an immunocompromised patient in whom mycobacterical DNA was not demonstrated by PCR. However, the diagnosis of latent tuberculous infection was supported by IFN-gamma assay (QuantiFERON(R)-TB Gold test) and tuberculous lymphadenitis was diagnosed. The skin lesions responded dramatically to anti-tuberculous therapy, and there has been no evidence of recurrence.
DNA ; Erythema Induratum ; Humans ; Hypersensitivity ; Immunocompromised Host ; Lichens ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Recurrence ; Skin ; Tuberculosis ; Tuberculosis, Cutaneous ; Tuberculosis, Lymph Node

No abstract available.
Lymphadenitis* ; Parotid Gland* ; Tuberculosis, Cutaneous* ; Tuberculosis, Lymph Node

PURPOSE: The purpose of our study was to evaluate clinical and CT findings of paradoxical response during treatment for abdominal tuberculosis. MATERIALS AND METHODS: Authors reviewed the patient records of 138 patients with abdominal tuberculosis during a recent 6-year period and we selected 11 patients with a paradoxical response. The CT findings and pathologic findings of the initial lesions and new lesions were reviewed. The intervals between initiation of therapy and the detection of new lesions, improvement of new lesions and the final follow-up were evaluated. RESULTS: At the initial presentation, we identified tuberculous peritonitis in 8 patients, tuberculous lymphadenitis in 3 patients and ileocolic tuberculosis in two patients. New lesions were identified at 2-10 months (mean: 3.8 months) after the initiation of therapy and following improvement of the initial lesions. The new lesions were perihepatic caseous abscess (n=4), hepatic tuberculoma (n=3), hepatic caseous abscess (n=1), tuberculous lymphadenitis (n=3), ileocolic tuberculosis (n=3), and splenic tuberculoma (n=1). Improvement of new lesions was noted at 4-14 months (mean: 7.6 months). At the final follow-up of seven patients, the new lesions disappeared and four patients still had small residual lesions. CONCLUSION: New lesions that develop in a patient with initial improvement should be considered a paradoxical response that will ultimately improve with continuation of the original medication.
Abscess ; Follow-Up Studies ; Humans ; Peritonitis, Tuberculous ; Tuberculoma ; Tuberculosis* ; Tuberculosis, Gastrointestinal ; Tuberculosis, Lymph Node

Lichen scrofulosorum, also known as Tuberculosis cutis lichenoides, is thought as a tuberculid such as Erythema induratum, Papulonecrotic tuberculid, Tuberculosis miliaris disseminata and Lupus miliaris disseminatus faciei. The lesions of Lichen scrofulosorum are pin-head sized or smaller, normal skin or reddish brown colored, arranged in nummular groups, usually on the trunk, where they persist unchanged or undergo spontaneous involution. As a rule, they appear in children who have tuberculosis of the bones or the lymphnodes. We report a case of Lichen scrofulosorum, 13-year old girl, who showed clinically and histologically typical lesions on the trunk. She was highly sensitive to Mantoux test and had tuberculous lymphadenitis of left cervical lymphnodes, but the chest was negative. Many challenges to the tuberculous origin of the tuberculids including Lichen scrofulosorum have prevailed for the last decade, Several studies and reports indicated that healing responses of Erythema induratum and other tuberculids to corticosteroids were more definite than to anti-tuberculosis drugs. But more recently, some reports recommended that anti-tuberculosis drugs were eftective than corticosteroids (in the treatment of Erythema induratum and other tuberculids). In this case anti-tuberculosis treatment with PAS 10gm., INH 400 mg., and streptomycin 1.0 gm. daily for the first one month and then 1.0gm. twice a week has remarkably improved the clinical manifestation in follow-up of three months. While the follow-up period was no enough, we strongly suggest the tuberculous origin of Lichen scrofulosorum.
Adolescent ; Adrenal Cortex Hormones ; Child ; Erythema Induratum ; Female ; Follow-Up Studies ; Humans ; Lichens* ; Skin ; Streptomycin ; Thorax ; Tuberculosis ; Tuberculosis, Cutaneous ; Tuberculosis, Lymph Node

The pathogeoesis of papulonecrotic tuberculid had been thought to be the result of hernatogenous dissemination from primary tuberculous focus of other organs. But, today, the existence of papulonecrotic tuberculid as a rare cutaneous reaction to the Mycobacterium bacillus is questioned. Papulonecrotic tuberculid is, however, a real entity in underdeveloped countries where tuberculosis is more common. We report a case having papulonecrotie tuberculid associated with cervical lymph node tuberculosis confirmed by typical histopathology and by clinical response to antituberculous chemotherapy. This case supports Iden et al's view (1) that skepticism regarding the existence of papulonecrotic tuberculid is probably the result of the current decreased prevalence of untreated tuberculosis and consequently increased rarity of this entity.
Bacillus ; Drug Therapy ; Mycobacterium ; Prevalence ; Tuberculosis ; Tuberculosis, Cutaneous* ; Tuberculosis, Lymph Node

BACKGROUND: It is well known that the cutaneous tuberculosis especially skin tuberculids is difficult to detect early and make a confirm diagnosis because the organism is seldom detected in a lesion by conventional methods such as AFB stain and culture. The polymerase chain reaction is a very powerful molecular biological tool in diagnosing infectious, neoplastic and genetic diseases. It has the merit of employing various samples, and to improving sensitivity by the modification of PCR techniques. Usage of the routinely formalin-fixed paraffin-embedded tissue as a sample for PCR is very useful in clinical examination, however the sensitivity and specificity have been known to be decreased. OBJECTIVE: To evaluate the efficacy of the nested-PCR in the diagnosis of different types of cutaneous tuberculosis, we tried to detect the DNA of Mycobacterium tuberculosis from routinely formalin-fixed paraffin-embedded tissue. METHODS: The various cutaneous tuberculosis and infectious granulomatous disease were retrospecitively selected by the findings of clinical, histopathological and bacterial culture. There were 9 cases of lupus vulgaris, 4 tuberculosis verrucosa cutis, 2 papulonecrotic tuberculid, 2 erythema induratum and 4 lupus miliaris disseminatus faciei. To amplify the 123bp DNA fragment of a repeated insertion sequence IS6110, two pairs of primers composing outside and inside primers were applied. RESULTS: The positive band was found in 10(91% ) of lupus vulgaris, 3 of tuberculosis verrucosa cutis, 1 papulonecrotic tuberculid and 1 erythema induratum. Four of the LMDF and 5 of the infectious granulomatous diseases were negative. CONCLUSION: The nested-PCR using routinely formalin-fixed paraffin-embedded tissue is a useful diagnostic tool if combined with the result of other clinical data. Also it may provide further insight into pathogenesis of skin tuberculids and the differential diagnosis of granulomatous skin diseases.
Diagnosis ; Diagnosis, Differential ; DNA ; Erythema Induratum ; Lupus Vulgaris ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Skin Diseases ; Skin* ; Tuberculosis ; Tuberculosis, Cutaneous*

BACKGROUND: It is well known that the cutaneous tuberculosis especially skin tuberculids is difficult to detect early and make a confirm diagnosis because the organism is seldom detected in a lesion by conventional methods such as AFB stain and culture. The polymerase chain reaction is a very powerful molecular biological tool in diagnosing infectious, neoplastic and genetic diseases. It has the merit of employing various samples, and to improving sensitivity by the modification of PCR techniques. Usage of the routinely formalin-fixed paraffin-embedded tissue as a sample for PCR is very useful in clinical examination, however the sensitivity and specificity have been known to be decreased. OBJECTIVE: To evaluate the efficacy of the nested-PCR in the diagnosis of different types of cutaneous tuberculosis, we tried to detect the DNA of Mycobacterium tuberculosis from routinely formalin-fixed paraffin-embedded tissue. METHODS: The various cutaneous tuberculosis and infectious granulomatous disease were retrospecitively selected by the findings of clinical, histopathological and bacterial culture. There were 9 cases of lupus vulgaris, 4 tuberculosis verrucosa cutis, 2 papulonecrotic tuberculid, 2 erythema induratum and 4 lupus miliaris disseminatus faciei. To amplify the 123bp DNA fragment of a repeated insertion sequence IS6110, two pairs of primers composing outside and inside primers were applied. RESULTS: The positive band was found in 10(91% ) of lupus vulgaris, 3 of tuberculosis verrucosa cutis, 1 papulonecrotic tuberculid and 1 erythema induratum. Four of the LMDF and 5 of the infectious granulomatous diseases were negative. CONCLUSION: The nested-PCR using routinely formalin-fixed paraffin-embedded tissue is a useful diagnostic tool if combined with the result of other clinical data. Also it may provide further insight into pathogenesis of skin tuberculids and the differential diagnosis of granulomatous skin diseases.
Diagnosis ; Diagnosis, Differential ; DNA ; Erythema Induratum ; Lupus Vulgaris ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Skin Diseases ; Skin* ; Tuberculosis ; Tuberculosis, Cutaneous*

No abstract available.
Tuberculosis* ; Tuberculosis, Lymph Node*