Tuberculosis cutis colliquativa

Last Updated: 2019-08-26

Author(s): -

Skrofuloderm, Skrophuloderm, Scrofuloderm, Skrophuloderm.

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

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

Especially per continuitatem (in organ tuberculosis), more rarely exogenous, developing skin tuberculosis.

  • Disseminated, livid, indolent nodules at various sites. Ulceration, fistula formation and emptying as well as perforation may occur.
  • To exclude system involvement:
  • Thorax X-ray or CT thorax.

  • Sonography of the abdomen and kidneys.
  • In the morning (fasting up to 4h) on 3 consecutive days sputum must be collected.

  • In the morning, give urine on 3 consecutive days (fluid restriction the evening before!).

  • Bronchoalveolar lavage (BAL). 

  • Medical history.
  • Clinic.
  • Thorax X-ray or CT thorax.

  • Sonography of the abdomen and kidneys.

  • Biopsy.
  • Tuberculin test (Mendel-Mantoux).
  • Quantiferon test. 
  • Cervical.

Central colliquation necroses and peripheral tuberculoid granulomas are visible.
  

  • Scarred healing.
  • Recurrent node eruptions possible. 

Therapy schedule:

The initial phase should last 8 weeks/2 months. During this time, the majority of bacteria are killed. In the following therapy phase (which lasts for months), an attempt is made to eliminate the remaining bacteria. The antituberculous therapy should be continued for at least 2 months after the absence of skin symptoms.

 

The therapy should last individually between 12-24, but at least 6 months!

 

Induction phase (2 months):

  • Rifampicin p.o. 10 mg/kg bw/d
  • Isoniazid p.o. 5 mg/kg bw. (with Vit B 6)
  • Pyrazinamid 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 month at ½ . 

 

·         Consolidation phase:

  • Induction phase (2 months):
  • Rifampicin p.o. 10 mg/kg bw/ d
  • Isoniazid p.o. 5 mg/kg bw. (with Vit B 6)

  • Ethambutol p.o. 15 mg/kg bw/d (may be omitted if isoniazid resistance has been excluded)

  • HIV Patients: Therapy must be done at ≥ for 7 months. Ethambutol should be replaced by streptomycin p.o. 15-20 mg/kg bw/d (from > 60 years max 750 mg) in case of additional therapy with NNRTI. 

 

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  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.