Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For a definitive diagnosis of cutaneous tuberculosis the demonstration of mycobacteria is essential, but this is generally not possible in skin lesions. Routinely available techniques have poor sensitivity and are time consuming, therefore, delaying the institution of timely therapy. The high sensitivity and speed of polymerase chain reaction (PCR) for the detection of infectious agents has prompted investigators to use this technique for the detection of Mycobacterium tuberculosis in body fluids such as cerebrospinal fluid or pleural fluid. In the present study, PCR was used to examine punch biopsy specimens from the affected skin of 10 patients with clinical diagnoses of tuberculosis verrucosa cutis, lupus vulgaris, scrofuloderma, papulonecrotic tuberculide and erythema induratum. A control group of 20 patients included individuals having skin manifestations with definite clinical diagnoses other than cutaneous tuberculosis, such as leprosy, fungal mycetoma, chronic bullous disease of childhood and pemphigus vulgaris. The PCR amplified products were dot hybridized with a probe which was random prime labelled with 32P. The results were compared with routine microbiological and histological findings. Among the test group, six of 10 (60%) were positive for M. tuberculosis by PCR, although their histopathology showed non-specific chronic inflammation with no definite diagnosis. Microbiological investigations, including acid-fast bacillus smear and culture, were positive in a single case of scrofuloderma. All patients in the control group were negative by PCR for M. tuberculosis. The data indicate that the combination of dot hybridization with PCR markedly increased the sensitivity and specificity of PCR. This may be a useful tool in the diagnosis of tuberculosis when conventional methods fail.
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PMID:Development of a polymerase chain reaction dot-blotting system for detecting cutaneous tuberculosis. 1065 97

As we move into the 21st century, cutaneous tuberculosis has re-emerged in areas with a high incidence of HIV infection and multi-drug resistant pulmonary tuberculosis. Mycobacterium tuberculosis, Mycobacterium bovis, and the BCG vaccine cause tuberculosis involving the skin. True cutaneous tuberculosis lesions can be acquired either exogenously or endogenously, show a wide spectrum of morphology and M. tuberculosis can be diagnosed by acid-fast bacilli (AFB) stains, culture or polymerase chain reaction (PCR). These lesions include tuberculous chancre, tuberculosis verrucosa cutis, lupus vulgaris, scrofuloderma, orificial tuberculosis, miliary tuberculosis, metastatic tuberculosis abscess and most cases of papulonecrotic tuberculid. The tuberculids, like cutaneous tuberculosis, show a wide spectrum of morphology but M. tuberculosis is not identified by AFB stains, culture or PCR. These lesions include lichen scrofulosorum, nodular tuberculid, most cases of nodular granulomatous phlebitis, most cases of erythema induratum of Bazin and some cases of papulonecrotic tuberculid. Diagnosis of cutaneous tuberculosis is challenging and requires the correlation of clinical findings with diagnostic testing; in addition to traditional AFB smears and cultures, there has been increased utilization of PCR because of its rapidity, sensitivity and specificity. Since most cases of cutaneous tuberculosis are a manifestation of systemic involvement, and the bacillary load in cutaneous tuberculosis is usually less than in pulmonary tuberculosis, treatment regimens are similar to that of tuberculosis in general. In the immunocompromised, such as an HIV infected patient with disseminated miliary tuberculosis, rapid diagnosis and prompt initiation of treatment are paramount. Unfortunately, despite even the most aggressive efforts, the prognosis in these individuals is poor when multi-drug resistant mycobacterium are present. An increased awareness of the re-emergence of cutaneous tuberculosis will allow for the proper diagnosis and management of this increasingly common skin disorder.
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PMID:Cutaneous tuberculosis: diagnosis and treatment. 1206 38

Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis primarily occurring in developing countries. The recent increase in the incidence of tuberculosis, especially due to human immunodeficiency virus (HIV) infections, has led to a resurgence of extrapulmonary forms of this disease. We describe a case of lupus vulgaris in a 33-year-old woman who had a 5-year history of a slowly growing plaque on her neck. The lesion was located at the site of surgery repairing the scar resulting from the incision of a subcutaneous abscess during childhood. This lesion was misdiagnosed as bacterial abscess. Histopathologic examination of the plaque revealed non-caseating tuberculoid granulomas consisting of lymphocytes, epithelioid and giant cells. Staining for acid-fast bacilli and culture from biopsied tissue was negative. Polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis DNA, performed on a skin biopsy specimen, was positive. A diagnosis of lupus vulgaris developing at the site of a previous misdiagnosed scrofuloderma was made. Conventional antitubercular therapy with rifampicin, isoniazid and ethambutol was administered for 6 months, resulting in resolution of the lesion.
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PMID:Lupus vulgaris developing at the site of misdiagnosed scrofuloderma. 1270 74

We describe an 11-year-old boy who had several, asymptomatic, erythematous papules in the oropharynx and larynx with recent onset, two cervical lymphadenopathies, and a painless, erythematous plaque on the right wrist with a 2.5-year history of slow growth. Histologic examination of the mucocutaneous lesions revealed a submucous infiltrate of lymphocytes and Langhans giant cells in the papules and granulomatous dermatitis in the plaque. The cervical lymph node was biopsied and on the surgical scar, an erythematous, nodular lesion developed. A biopsy specimen of this lesion showed tuberculoid granulomas with prominent caseation necrosis, and culture was positive for Mycobacterium tuberculosis. The Mantoux test was strongly positive with a vesicular response. A diagnosis of mucocutaneous lupus vulgaris and scrofuloderma secondary to cervical tuberculous lymphadenitis was made. Two months after initiation of antituberculosis therapy there was a complete resolution of mucous lesions and healing with atrophic scars on the neck and wrist. This is a rare presentation in the literature and reminds clinicians that tuberculosis should be kept in mind in the differential diagnosis of oral cavity lesions.
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PMID:Tuberculosis in a child presenting as asymptomatic oropharyngeal and laryngeal lesions. 1452 63

Since Laennec's description of the "prosector's wart" in 1826, science has made great strides forward. The cutaneous forms of the infection with Mycobacterium tuberculosis are various. The most common clinical forms of cutaneous tuberculosis are lupus vulgaris and scrofuloderma. The clinical forms of cutaneous tuberculosis are usually classified according to the patient's immune status, and the way through which the skin has been infected. Nonetheless, as in leprosy, a classification based on the importance of the bacterial inoculum in situ is possible. Subsequently the diagnosis should be considered as easy in the multibacillary forms and much more difficult in the paucibacillary forms. In the former, the diagnosis should rely on bacteriological data. In the latter, the diagnosis will rely on the association of epidemiological, clinical and histological data whereas genomic amplification with PCR may be of potential interest.
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PMID:[Clinical forms of the cutaneous tuberculosis]. 1501 40

Although there has been a steady decline in the incidence of tuberculosis in recent years, it persists in some regions, and where AIDS is especially prevalent, the number of new cases has been increasing. Thus, cutaneous tuberculosis has re-emerged in areas with a high incidence of HIV infection and multidrug-resistant pulmonary tuberculosis. Lupus vulgaris has been and remains the most common form of cutaneous tuberculosis. Cutaneous manifestations of disseminated tuberculosis are unusual, being seen in less than 0.5% of cases. Scrofuloderma, tuberculosis verrucosa cutis and lupus vulgaris comprise most cutaneous tuberculosis cases. Bacillus Calmette-Guerin (BCG) is derived from an attenuated strain of Mycobacterium bovis and is employed beneficially as a relatively safe vaccination in Poland and other countries in which the prevalence of tuberculosis is high. However, BCG vaccination may produce complications, including disseminated BCG and lupus vulgaris, the latter seen in one of our two patients in whom lupus vulgaris at the inoculation site followed a second vaccination with BCG 12 years after the initial one. A similar phenomenon has been described after immunotherapy with BCG vaccination. Re-infection (secondary) inoculation cutaneous tuberculosis may also occur as a result of BCG vaccination, producing either lupus vulgaris or tuberculosis verrucosa cutis, probably depending upon the patient's degree of cell-mediated immunity. However, most lupus vulgaris cases are not associated with vaccination with BCG, as occurred in our first patient. For those who do develop lupus vulgaris, it can be persistent for a long period, in some cases for many decades. In the second patient we describe a lengthy duration and cutaneous reactivation at distant sites after more than 40 years.
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PMID:Lupus vulgaris: report of two cases. 1581 Oct 81

Lupus vulgaris is the most frequent form of cutaneous tuberculosis in industrialized countries. It is a chronic and benign form of cutaneous tuberculosis that usually occurs in patients previously sensitized to Mycobacterium tuberculosis. The histopathological study shows tuberculoid granulomas that usually contain Langhans-type giant cells. Caseous necrosis is not normally found. The culture is negative in most patients. On the other hand, the Mantoux test is usually highly positive. We present the case of a 58-year-old male who developed lupus vulgaris on the left cheek over a nine-year period, and who had another similar lesion on the edge of a residual scar on the left forearm from a probable scrofuloderma suffered during childhood.
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PMID:[50-year case of lupus vulgaris]. 1647 57

Despite prevention programs, tuberculosis is still endemic in developing countries. We assessed the epidemiologic and clinical profiles of childhood cutaneous tuberculosis in our dermatology department from 1981 to 2000 and compared it to previous Tunisian reports and to the relevant literature. This is a retrospective study over a 20-year period (1981-2000) in a large teaching hospital of the capital. Patients included were below age 15 years. Diagnosis was based upon clinical examination, tuberculin reaction, histopathology and response to antitubercular therapy. There were 26 patients with cutaneous tuberculosis, 0.1 percent of the total number of dermatology outpatients for that time period. Of these 26, seven (27 %) were immunocompetent. There were four boys and three girls and the mean age was 9.5 years. Three patients had lupus vulgaris, three had scrofuloderma, and one child had orificial tuberculosis. Six out of seven children were BCG vaccinated. There was no family history of tuberculosis. The Mantoux reaction was positive in six children. There was no systemic organ involvement in all cases. All patients were treated successfully with triple or quadruple anti-tubercular drugs for 4-11 months. Compared to a previous Tunisian report conducted over an 8-year period in the seventies, the incidence of childhood cutaneous tuberculosis has decreased. In that report, scrofuloderma was the most frequent form. Currently the incidence of lupus vulgaris has reached that of scrofuloderma, demonstrating the increase of the clinical pattern associated with strong immunity. All children had localized disease and responded to antimycobcterial chemotherapy.
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PMID:Childhood cutaneous tuberculosis: a 20-year retrospective study in Tunis. 1663 25

Cutaneous tuberculosis may be associated with concurrent systemic foci in the body such as lung, lymph node, bone or CNS. Phlyctenular keratoconjunctivitis (PKC) is a manifestation of immunological response to a variety of antigens in the eye, tubercular focus (evident or occult) being the commonest in India. Reports in the existing literature have shown lungs and lymph nodes to be the predominant underlying focus associated with PKC, whereas cutaneous tuberculosis has seldom been found in this situation. We report this forgotten association in two children with cutaneous tuberculosis, one each with lupus vulgaris and scrofuloderma, who also had PKC. Interestingly, one of the cases also had simultaneous lichen scrofulosorum, which is also an immunological response to tubercular antigen and manifests in the skin, thus showing immunological manifestation in two different organ systems along with cutaneous focus of tuberculosis.
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PMID:Cutaneous tuberculosis and phlyctenular keratoconjunctivitis: a forgotten association. 1688 May 76

The present study highlights the role of fine-needle aspiration cytology (FNAC) and Ziehl Neelsen (ZN) staining in diagnosis of cutaneous tuberculosis and correlates the cytomorphological features with histopathology.FNAC and biopsy was performed on 30 cases of cutaneous tuberculosis and along with the routine stains, ZN and periodic acid Schiffs staining was carried out in all cases. On cytology, out of 9 cases of lupus vulgaris, 89% showed cohesive epithelioid cell granulomas with or without chronic inflammatory infiltrate; however, acid fast bacilli (AFB) could be demonstrated only in 22.2% on cytology while none on histopathology. Of 19 cases diagnosed as Scrofuloderma, 79% showed caseation necrosis with or without granulomas, 10.5% revealed granulomas with acute inflammatory infiltrates. AFB was demonstrated in 78.9% cases on cytology when compared with 15.8% on histopathology. No conclusion could be drawn in one case each of TBVC and lichen scrofulosorum.Hence, correlating cytomorphological patterns with clinical presentations often yields diagnostic information in cases of cutaneous tuberculosis and frequently obviates the need for biopsy especially in cases of scrofuloderma.
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PMID:The role of fine-needle aspiration cytology and Ziehl Neelsen staining in the diagnosis of cutaneous tuberculosis. 1711 40


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