Disseminated Tuberculosis Presenting with Scrofuloderma and Anterior Staphyloma in a Child in Sokoto, Nigeria

摘要

Introduction: Disseminated tuberculosis (TB) may occur with skin and ocular involvement which are not common manifestations in children and may lead to debilitating complications. Objective: A child with multi-organ TB involving the lungs, chest abdomen, skin and eyes who had been symptomatic for 3 years is reported. Case Report: A 6-year-old girl presented with recurrent fever, abdominal pain and weight loss of 3 years and skin lesions of a year duration. There was history of pain and redness of the eyes associated with discharge. She was not vaccinated at all. She was chronically ill-looking with bilateral conjunctival hyperaemia, purulent eye discharge with corneal opacity of the right eye. She had significant lymphadenopathy, digital clubbing and ulcerated, discharging swellings around her neck and axilla (scrofuloderma). She had reduced breath sounds and coarse crepitations. Hepatosplenomegaly and ascites were present. She later developed bulging of the upper part of the cornea of the right eye which was diagnosed by the ophthalmologist to be cornea ulcer with anterior staphyloma. Results, Treatment and Outcome: Complete blood count (leucocytosis 12,800 cells), erythrocyte sedimentation rate (150 mm/hr) and tuberculin test (7 mm induration) were suggestive of TB. Radiological tests were also supportive. She received anti-Kochs in addition to systemic and ocular antibiotics. Skin lesions healed progressively and stopped discharging. Caregivers were counseled on poor visual prognosis of the right eye. She was discharged but lost to follow up. Conclusion: Multi-organ involvement of TB especially ocular and cutaneous TB is not common but is very debilitating. More preventive efforts with vaccination and expertise are needed at lower levels of health care in the community to aid early diagnosis.