Atypical presentations of mucocutaneous TB in HIV: A case series from South Africa

IF 1.9 Q3 INFECTIOUS DISEASES

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Pub Date : 2025-04-06 DOI:10.1016/j.jctube.2025.100524

Mahlatse Cordelia Kgokolo , Mohlominyane Jeffrey Mokheseng , Jabulile Johanna Makhubele , Shalate Charlotte Siwele , Tinashe Irvin Maphosa , Tsholofelo Kungoane

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引用次数: 0

Abstract

Introduction

Tuberculosis (TB) remains a major burden of disease worldwide, especially in Human immunodeficiency virus (HIV)-infected patients. Cutaneous forms of TB account for approximately 10 % of all extrapulmonary tuberculosis cases, with oral manifestations accounting for less than 1 % of these cases. A high index of suspicion is essential when diagnosing rare clinical presentations. The response to treatment is excellent in most patients, particularly those receiving concomitant, effective antiretroviral (ARV) treatment.

Patient presentation

We report two cases of lupus vulgaris in AIDS patients (CD4 count of 113 cells/mm³ and 172 cells/mm³, respectively) and one case of mucosal TB in a patient with CD4 count of 365 cells/mm³. All the patients were adults referred to the dermatology clinic. The atypical clinical presentations included papules, plaques, and ulcers affecting unusual sites, such as the upper and lower limbs in the case of lupus vulgaris and a tongue ulcer in the patient with oral TB, emphasizing the importance of strong suspicion in HIV-infected patients. All available diagnostic measures were used to confirm the diagnosis.

Management

We demonstrate the importance of multidisciplinary care for patients and an excellent response to anti-TB treatment once diagnosed. We also emphasize the importance of concomitant ARV treatment and patient follow-up.

Conclusion

The outcomes of two of the three patients were good, highlighting the importance of timely clinical diagnosis and treatment, including monitoring and follow-up, while ensuring continued ARV treatment.

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非典型表现的粘膜皮肤结核艾滋病毒：来自南非的病例系列

结核病（TB）仍然是世界范围内疾病的主要负担，特别是在人类免疫缺陷病毒（HIV）感染患者中。皮肤结核约占所有肺外结核病例的10% %，口腔结核占这些病例的不到1% %。在诊断罕见的临床表现时，高度怀疑是必不可少的。大多数患者对治疗的反应非常好，特别是那些同时接受有效抗逆转录病毒（ARV）治疗的患者。我们报告了2例艾滋病患者的寻常性狼疮（CD4计数分别为113细胞/mm3和172细胞/mm3）和1例粘膜结核患者的CD4计数为365细胞/mm3。所有的患者都是转介到皮肤科诊所的成年人。非典型临床表现包括丘疹、斑块和影响不寻常部位的溃疡，如寻常性狼疮患者的上肢和下肢以及口腔结核患者的舌溃疡，这强调了对hiv感染患者进行强烈怀疑的重要性。所有可用的诊断方法均用于确诊。我们证明了多学科治疗对患者的重要性，以及一旦诊断出抗结核治疗的良好反应。我们还强调同时进行抗逆转录病毒治疗和患者随访的重要性。结论3例患者中2例预后良好，突出了及时临床诊断和治疗的重要性，包括监测和随访，同时确保持续抗逆转录病毒治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine

CiteScore

4.00

自引率

5.00%

发文量

审稿时长

30 weeks

期刊介绍： Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.