Tuberculosis cutis colliquativa

Scrofuloderm, scrophuloderm, scrofuloderm, scrophuloderm.

Cutaneous form of tuberculosis, which can lead to melting and subcutaneous fistula formation.

Especially in immunocompromised patients and the elderly, as well as children.

V.a. per continuitatem (in organ tuberculosis), more rarely exogenously, developing skin tuberculosis.

• Disseminated, livid, indolent nodules in various locations. Ulceration, fistulation, perforation may occur.
• To exclude systemic involvement:
• Thoracic X-ray or CT chest.
• Sonography of the abdomen and kidneys.
• In the morning (fasting up to 4h) on 3 consecutive days, sputum must be collected.
• Pass urine on 3 consecutive days (fluid restriction the evening before!).
• Bronchoalveolar lavage (BAL).

• Anamnesis.
• Clinical.
• Thoracic X-ray or CT thorax.
• Sonography of the abdomen and kidneys.
• Biopsy.
• Tuberculin test (Mendel-Mantoux).
• Quantiferon test.

• Cervical.

Central colliquative necrosis and, peripherally, tuberculoid granulomas are seen.

• Scarring healing.
• Recurrent nodal eruptions possible.

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 be continued on an individual basis for 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 NNRTI.

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.