Atypical Variant of Cutaneous Tuberculosis Presentation in an Adult HIV-Infected Patient in an Emergency Department in Haiti

摘要

The incidence of tuberculosis (TB) has increased in the 21st century due to a high prevalence of the human immunodeficiency virus (HIV) infection and multidrug-resistant (MDR) pulmonary TB. HIV infection, diabetes mellitus, and other immune deficiencies decrease cure rates, increase mortality, and increase the incidence of MDR pulmonary TB. Tuberculosis is the most virulent opportunistic pathogen worldwide for patients living with HIV. This case documents rare clinical manifestation of cutaneous tuberculosis (CTB) seen in an emergency department in Gonaives, Haiti. Cutaneous TB can occur either from the spread of TB from an endogenous origin or from the entry of mycobacteria into the skin. The host's immune response to mycobacteria is an important factor. There are several findings that support diagnosis of a tuberculid, including failure to detect mycobacterium TB in stains or cultures of affected tissue, frequent resolution of skin lesions with anti-TB therapy, a strongly positive tuberculin skin test, a positive interferon-γ release assay, presence of an endogenous TB infection, and granulomatous tissue present in histopathology. This case study illustrates the challenges providers face to diagnose a patient with CTB and the many differential diagnoses that must be considered. Once a definitive diagnosis has been made, this article highlights disease course, progression, and treatment plan.