Tuberculosis cutis miliaris disseminata

Last Updated: 2019-08-26

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Cutaneous miliary tuberculosis.

Miliary tuberculosis of the skin due to haematogenic sowing. This occurs primarily in immunosuppressed patients or children or the elderly.

In particular, infants, young children, the elderly and immunocompromised people are affected.

  • Hematogenic sowing of tubercle bacteria leads to miliary tuberculosis.
  • There are plenty of pathogens in the cutaneous lesions.
  • Partially ulcerating, dense erythematous-brownish, haemorrhagic papules.
  • Enormous involvement is possible. 

  • Travel medical history
  • Clinic.
  • Tuberculin test.
  • Tuberculin test (Mendel-Mantoux) often negative.
  • Quantiferon test.

  • Biopsy.

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 on 3 consecutive days urine must be given (fluid restriction the evening before!).

  • Bronchoalveolar lavage (BAL).

In most cases, disseminated organ infestation occurs.

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 ½ month.

 

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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