Tuberculosis fungosa serpiginosa

Last Updated: 2019-08-26

Author(s): -

Rare cutaneous form of tuberculosis with "fungal" skin lesions. 

  • Very rare skin tuberculosis.
  • Especially in elderly people.

Both by exogenous and endogenous inoculation.

  • Localization 
    • Forearms and back of the hand.
  • Papillomatous, fistulating, perforating growths through which a cloudy or purulent secretion can be emptied.
      

  • Travel anamnesis
  • Clinic.
  • Tuberculin test negative. 

  • Tuberculin test is negative. 

  • Quantiferon test.

  • Microscopically, however, pathogen detection is possible.

  • Biopsy (both dermatopathological and microbiological examination).

  • 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).

Tuberculoid granulomas with inflammatory infiltrate.

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.

  • Moist, antiseptic compresses e.g: Lavasept®-Lsg. or Octenisept®-Lsg.

  • Surgical removal if necessary.

 

  1. Handog, E. (2016). Cutaneous manifestations of tuberculosis. Uptodate.com. Retrieved 24 May 2016, from http://www.uptodate.com/contents/cutaneous-manifestations-of-tuberculosis?source=search_result&search=tuberkulosis+skin&selectedTitle=1~16
  2. Haas, W. (2016). RKI - RKI-Ratgeber für Ärzte - Tuberkulose. Rki.de. Retrieved 24 May 2016, from https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Tuberkulose.html#doc2374486bodyText3