Tuberculosis cutis verrucosa

Last Updated: 2021-11-19

Author(s): Anzengruber F., Navarini A.

ICD11: 1B12.8

Riehl and Paltauf 1886.

Tuberculum anatomicum, butcher's tubercle, verruca necrogenica, warty skin tuberculosis, light tubercle.

  • Rare post-primary inoculation tuberculosis in a normal reaction situation.
  • Slaughterhouse tubercle: infection with Mycobacterium bovis, which is localised and wart-like. There is usually no involvement of the lymph nodes.
  • Light tubercle (Verruca necrogenica): Mycobacterium tuberculosis causes erythematous, indolent, verruciform papules or papulopustules with inflammatory surrounding redness after a few days of inoculation. In the course, central atrophy may occur. Lymphangitis may occur concomitantly.

Butchers, veterinarians, farmers, anatomists and pathologists are particularly affected.

The infection occurs through small skin lesions after a patient has already undergone a primary tuberculous complex.

Erythematous papules with surrounding inflammation, which are progressive peripherally and heal centrally with scarring.

Locoregional lymph node adenopathy.

  • Clinical.
  • Anamnesis.
  • Tuberculin test (Mendel-Mantoux).
  • Quantiferon test.
  • Biopsy.

To exclude systemic involvement:

  • Thoracic 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.
  • Pass urine in the morning on 3 consecutive days (fluid restriction the evening before!).
  • Bronchoalveolar lavage (BAL).

Hands and feet.

Tuberculoid structures without caseation, pseudoabscesses, pseudoepitheliomatous widening of the epidermis with hyper- and parakeratosis.

Excision.

Therapy regimen:

  • The initial phase should last for 8 weeks/2 months. During this time, the majority of 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. Barbagallo J, Tager P, Ingleton R, Hirsch RJ , Weinberg JM. Cutaneous tuberculosis: diagnosis and treatment. Am J Clin Dermatol 2002;3:319-28.
  2. Riehl G , Paltauf R. Tuberculosis verrucosa cutis. Vierteljahresschrift f Dermatol u Syph 1886;13:19-49.
  3. Sehgal VN, Sehgal R, Bajaj P, Sriviastava G , Bhattacharya S. Tuberculosis verrucosa cutis (TBVC). Journal of the European Academy of Dermatology and Venereology 2000;14:319-21.