Tuberculosis cutis verrucosa

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.

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.