Tuberculosis subcutanea et fistulosa

Special form of tuberculosis cutis colliquativa.

Multiple fistulas with purulent secretion.

• Clinic.
• Biopsy (both dermatopathological and microbiological examination).
• Tuberculin test (Mendel-Mantoux).
• Quantiferon test.

• If necessary, e.g. systemic involvement:
• Thoracic X-ray or CT thorax.
• Sonography of the abdomen and kidneys.
• Collect sputum in the morning on 3 consecutive days (fasting up to 4 h).
• Pass urine in the morning on 3 consecutive days (fluid restriction the evening before!).
• Bronchoalveolar lavage (BAL).

In particular, localised in the anogenital region.

Abscesses, tuberculoid structures.

Therapy regimen:

• The initial phase should last for 8 weeks/2 months. During this time, the majority of the bacteria are killed. In the subsequent phase of therapy (lasting for months), attempts are made to eliminate the remaining bacteria. Antituberculous therapy should be continued for at least 2 months after the skin is free of symptoms.

• Therapy should last individually between 12-24, but at least 6 months!

Induction phase (2 months):

• Rifampicin p.o. 10 mg/kg bw/d
• Isoniazide p.o. 5 mg/kg bw. (with Vit B 6)
• Pyrazinamide p.o. 35 mg/ bw/ d if necessary combination with allopurinol!
• Ethambutol p.o. 15 mg/kg bw/ d
• A clear improvement can be seen in the vast majority of cases after 1 ½ months.

- Consolidation phase:

• Induction phase (2 months):
• Rifampicin p.o. 10 mg/kg bw/ d
• Isoniazide p.o. 5 mg/kg bw. (with Vit B 6)
• Ethambutol p.o. 15 mg/kg bw/d (can also be omitted if isoniazid resistance has been ruled out)
• HIV patients: therapy must last ≥ 7 months. Ethambutol should be replaced by streptomycin p.o. 15-20 mg/kg bw/d (from > 60 y. max 750 mg) in case of additional therapy with NNRTIs.

1. Gupta M, Gupta M , Kaur R. Tuberculosis colliquativa cutis of the cheek: an extremely uncommon manifestation of primary extrapulmonary tuberculosis. BMJ Case Rep 2013;2013.
2. Sutor GC, Ockenga J, Kirschner P, Schatzle C, Mendila M, Jendro M et al. Tuberculosis cutis colliquativa during long-term immunosuppressive therapy for rheumatoid arthritis. Arthritis Rheum 1997;40:188-90.
3. Garb J. Tuberculosis cutis colliquativa (tuberculous gummas) healed rapidly with local application of promin jelly; report of a case. Arch Derm Syphilol 1948;58:308-13.
4. Cecchi R, Giomi A , Innocenti F. Guess what! Scrofuloderma (tuberculosis colliquativa cutis) of the left foot. Eur J Dermatol 1998;8:67-8.
5. Tur E, Brenner S , Meiron Y. Scrofuloderma (tuberculosis colliquativa cutis). Br J Dermatol 1996;134:350-2.