Tuberculosis ulcerosa mucosae et cutis
Last Updated: 2019-08-26
Tuberculous infestation of the mucous membranes occurring with pronounced immunosuppression.
Men from the middle age are preferably afflicted.
The disease occurs when the immunity situation is unfavourable.
- Enoral, perioral.
The term infectious tuberculosis refers to the infection of the sites through which secretions rich in tubercle bacteria are excreted (anus, rectum, kidney, lung).
Enoral (from larynx to lips) and perioral dolent, ulcerating papules and pustules.
CAVE: The contact density is particularly high due to the high number of tubercle bacteria in the skin lesions.
- Travel medical history
The tuberculin test is often false negative (due to the usually poor immune situation).
- Quantiferon test.
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).
Non-specific, cellular proliferating, partly necrotizing inflammation, tuberculoid granulomas.
In most cases, disseminated organ infestation occurs.
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 .
- 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 Patient: 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.
- Analgesic local therapeutics e.g.:
- Dynexan® Mouth Gel
- Neo-angin® forte.
- Barbagallo J, Tager P, Ingleton R, Hirsch RJ , Weinberg JM. Cutaneous Tuberculosis. American Journal of Clinical Dermatology 2002;3:319-28.
- Barbagallo J, Tager P, Ingleton R, Hirsch RJ , Weinberg JM. Cutaneous tuberculosis: diagnosis and treatment. Am J Clin Dermatol 2002;3:319-28.
- Rietbroek RC, Dahlmans RP, Smedts F, Frantzen PJ, Koopman RJ , van der Meer JW. Tuberculosis cutis miliaris disseminata as a manifestation of miliary tuberculosis: literature review and report of a case of recurrent skin lesions. Rev Infect Dis 1991;13:265-9.
- Sehgal VN, Bhattacharya SN, Jain S , Logani K. CUTANEOUS TUBERCULOSIS: THE EVOLVING SCENARIO. International Journal of Dermatology 1994;33:97-105.
- 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
- 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