Page 78 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 3 Case Report

Cutaneous tuberculosis in HIV-infected individuals:

Lessons learnt from a case series

Authors: Introduction: Extrapulmonary tuberculosis (TB) causes a significant burden of disease
Vhudzani Tshisevhe worldwide, especially among HIV-infected individuals and those with other immunosuppressive
1,2
2,3
Nontombi Mbelle
Remco P.H. Peters 2,4,5 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.
Affiliations: There is a paucity of published data on clinical presentation and outcome of cutaneous TB in
1 Lancet Laboratories, this context. Raising awareness of this condition among clinicians is imperative to improve
Rustenburg, South Africa
early diagnosis and optimise treatment outcomes.
2 Department of Medical Patient presentation: In this series, we present three cases of cutaneous TB, two adults and one
Microbiology, Faculty of
Health Sciences, University child, referred to a tertiary hospital from two primary healthcare centres and from a general
of Pretoria, Pretoria, practitioner. We demonstrate that the clinical presentation is diverse, ranging from papular
South Africa lesions to abscesses, and that concordant pulmonary TB may be present.

3 Department of Medical Management: In particular, we show the importance of performing diagnostic
Microbiology, Tshwane procedures (e.g. aspiration) in individuals presenting with an abscess that does not
Academic Division, National respond to broad spectrum antimicrobial treatment, particularly in those with advanced
Health Laboratory Service,
Pretoria, South Africa immunosuppression.
Outcome and conclusion: The outcome of our three patients was poor, highlighting the need
4 Department of Medical
Microbiology, School for for earlier diagnosis in this WHO Stage 4 condition and intensive management of clinical
Public Health and Primary cases.
Care, University of
Maastricht, Maastricht, Keywords: HIV-medicine; Retro-Viral Disease; Mycobacteria; Tuberculosis; Multidrug
the Netherlands Resistance; Cutaneous Tuberculosis; Cutaneous Disease; immunocompromised.

5 Anova Health Institute,
Johannesburg, South Africa Introduction
Corresponding author: Cutaneous Mycobacterium tuberculosis (MTB) infection is a form of extrapulmonary tuberculosis
Vhudzani Tshisevhe, (TB) that is uncommon: it accounts for less than 2% of all cases of TB. The incidence of
1,2
[email protected]
cutaneous TB has been reported to decrease in India while increasing incidence was reported
Dates: in Mexico; there are no time trend data for South Africa available. 2,3,4 The human
Received: 03 Aug. 2018 immunodeficiency virus (HIV) epidemic is an important driver of the occurrence of cutaneous
Accepted: 05 Feb. 2019
Published: 12 Mar. 2019 TB; other important factors are the increased rates of TB in specific settings such as healthcare
facilities, prisons and homeless shelters; intravenous drug use; diabetes mellitus; and
How to cite this article: immunosuppressive therapy. 5,6,7,8,9
Tshisevhe V, Mbelle N,
Peters RPH. Cutaneous
tuberculosis in HIV-infected The diagnosis of cutaneous TB is often challenging. Firstly, the clinical presentation of cutaneous
individuals: Lessons learnt TB is non-specific and variable. Furthermore, microbial diagnosis is complicated for reasons
from a case series. S Afr J including the paucibacillary nature of the skin lesions, requirements for prolonged incubation
HIV Med. 2019;20(1), a895.
https://doi.org/10.4102/ period of culture in the laboratory and the difficulties in extracting and detecting mycobacteria
sajhivmed.v20i1.895 from biopsy material. 2,5,10 Lastly, in our experience, the awareness of cutaneous TB among health
practitioners is low, which may result in delays. As a result, cutaneous TB is often diagnosed
relatively late and may have poor outcomes, despite the availability of effective anti-TB
treatment.

There is a paucity of data on the clinical and microbiological features of cutaneous TB and its
clinical outcomes in sub-Saharan Africa. To improve treatment outcomes, increased awareness of
Read online: this condition and the appropriate diagnostic work-up among healthcare workers is required.
Read online:
Scan this QR
Scan this QR
code with your
code with your Here, we describe three cases of cutaneous TB and present lessons learnt to improve daily clinical
smart phone or practice.
smart phone or
mobile device
mobile device
to read online.
to read online.
Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 71 Open Access