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Tuberculous gumma associated with idiopathic thrombocytopenic purpura: Report of a Japanese female patient
Author(s) -
MAEJIMA Hideki,
ARAI Satoru,
EBATA Toshiya,
TAKEDA Hiroshi,
KUSUNOKI Mai,
KATSUOKA Kensei
Publication year - 2007
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/j.1346-8138.2007.00223.x
Subject(s) - medicine , thrombocytopenic purpura , tuberculosis , lesion , mycobacterium tuberculosis , erythema , pathology , purpura (gastropod) , cord , syphilis , miliary tuberculosis , dermatology , surgery , platelet , ecology , family medicine , human immunodeficiency virus (hiv) , biology
Our patient was a 77‐year‐old Japanese woman, who was under treatment for idiopathic thrombocytopenic purpura (ITP) and chronic renal failure. She had warm nodules and cord‐like induration on her left knee that appeared similar to Bazin's erythema induratum. A chest X‐ray examination revealed miliary tuberculosis; after anti‐mycobacterial therapy, the warm nodules and cord‐like induration were transformed into a cold, non‐tender abscess that drained. Histopathological findings showed caseation necrosis in the subcutaneous tissue, however, mycobacteria were directly detected by Ziehl–Neelsen staining from cutaneous lesions, and cultures from the same lesion also grew Mycobacterium tuberculosis . Tuberculous gumma demonstrated multiple, cold, painless abscesses and thrombosis were also seen. This is a rare and unusual clinical form of cutaneous tuberculosis, and the result of hematogenous dissemination from a primary focus during periods of lowered resistance.