A case of tuberculosis cutis colliquativa treated with rifampicin and isoniazid.

Dear Sir or Madam, A 69-year-old woman was referred to our Department because of multiple abscesses on her neck (Fig. 1). On admission, ill-defined, erythematous, freely movable nodules with purulent discharge were located on both sides of the neck (Fig. 1). No other skin abnormalities were found. The patient was hospitalized. She had a fever (38.3°C), heart rate of 65 bpm, and blood pressure of 115/80 mmHg; there were no systemic symptoms of infection, and all the systems were clinically normal. The patient had no background of immunosuppression, no family history of tuberculosis, and had never received antituberculo-sis vaccines. Laboratory investigations revealed neu-trophil leukocytosis (WBC: 11240/μL, neutrophils: 85.2%), elevated C-reactive protein (1.87 mg/dL) and an elevated erythrocyte sedimentation rate (44 mm/ h). The tumoral marker values were normal. Serum human immunodeficiency virus (HIV) and Venereal Disease Research Laboratory (VDRL) tests were negative. Purified protein derivate (PPD) skin tests were positive after 48 hours. According to clinical data, a mycobacteriosis infection was suspected, so a needle aspiration biopsy of the most recent skin lesion was performed and the extracted material was subjected to both microbiological examination and molecular analysis. The needle aspiration biopsy smear using the Ziehl-Neelsen stain was positive. Cultures from the skin biopsy showed growth of Mycobacterium tuberculosis after 8 weeks. Antero-posterior chest X-ray imaging revealed pulmonary involvement: striae, nodular fibrosis, and pleural thickening. Abdominal echography was negative. All these findings were consistent with the diagnosis of tuberculosis cutis colliquativa (TCC), the most common form of cutane-ous tuberculosis in adults [1]. Antitubercular therapy was initiated with rifampicin 600 mg/day and isonia-zid 600mg/day, and the lesions showed an improvement within 3 weeks of therapy. On this regimen, the skin lesions cleared in two months. After eight weeks of therapy, the patients are usually no longer considered infectious, but still require long-term treatment for eradication, so medication was continued for a further 7 months; meanwhile, the peripheral blood count and renal and liver functions were steadily monitored. At the follow-up after 16 months, the patient remains in remission. TCC was formerly most common among children, as a consequence of Mycobacterium bovis infections of the tonsils and cervical lymph nodes. Today, cuta-neous tuberculosis is a rare infection, but is still present in immunocompromised patients (due to HIV, use of immunosuppressants, or malignancy), travelers, or immigrates from developing countries. Mycobacte-rium tuberculosis, Mycobacterium bovis, and the BCG vaccine can cause tuberculosis involving the skin. …