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Cutaneous Tuberculosis and Ami

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Farmer with single warty indurated lesion on dorsum of foot. Which of the following could be the lesion(LQ)

A Verruca vulgaris

B Tuberculosis verrucosa cutis
C Mycetoma

D Lichen planus hypertrophicus

Ans. B
Tuberculosis verrucosa cutis

TBVC is a form of TB seen in India with a verrucous plaque on exposed trauma prone site seen in farmers

Verruca = Seen on the soles

Mycetoma+ is a swelling not a verrucous plaque

LP= is itchy



1). It’s a verrucous (wart like) form of reinfection tuberculosis.

2). Synonymous - warty tuberculosis, prosectors wart, verruca-necrogenica, tuberculosis cutis verruca, postprimary inoculation tuberculosis, and verrucous tuberculosis.

3). It occurs when the skin of a previously infected or BCG-immunized host, possessing a moderate or high degree of immunity, is subjected to exogenous reinfection.

4). Reinoculation occurs at sites of minor abrasions or wounds.

5). It commonly occurs in physicians, pathologists, medical students, laboratory attendants, Veterinarians, farmers, and butchers (tuberculous cattle).

6). Autoinoculation from tuberculous sputum (rare).

7). Lesions most commonly occur on the hands and, in children, the lower extremities. Infection starts as an asymptomatic warty papule often mistaken for verruca vulgaris. Slow growth and irregular peripheral extension occur.

8). The lesion may show central involution with an atrophic scar or form massive papillary excrescence with fissures.

9). Pus and keratinous material may extrude from these fissures. Lesions usually are solitary, and regional nodes are not affected unless secondary bacterial infection occurs.

10). Lesions may evolve and persist for years. Spontaneous resolution with scarring can occur.

11). Histology shows pseudoepitheliomatous hyperplasia with marked hyperkeratosis and a dense inflammatory infiltrate of neutrophils and lymphocytes.

12). Abscesses form in the superficial dermis and epidermis. Epithelioid giant cells occur, but typical tubercles and acid-fast bacilli are rare.

Other forms of cutaneous TB

1. Primary-inoculation TB (tuberculous chancre)

2. Lichen scrofulosorum

3. Papulonecrotic tuberculid

4. Erythema induratum (Bazin disease)

5. Tuberculids

6. Lupus vulgaris

7. TB cutis orificialis

8. Scrofuloderma

9. Miliary TB of the skin

Cutaneous Tuberculosis and Ami Flashcard List

8 flashcards