Non-invasive management of suppurative skin nodule (metastatic cutaneous abscess): a suspected case of tuberculous gumma: “a case report.”

Abstract

The paradigm of cutaneous adverse drug reactions (CADRs) due to the resurgence of Dushi-visha (~cumulative poison) is less reported. Clinical evidence of Dushi-visha is not commonly diagnosed in the clinics. This is the era of polypharmacy; the long duration of medication along with a multi-therapeutic approach causes drug intolerance and complicates with reduced assimilation. Improper elimination causes an increased concentration of these medicines in the plasma and produces toxic side effects. These cumulative endotoxins are termed as Dushi-visha in Ayurveda. A 60-year-old male diagnosed with abdominal tuberculosis had undergone anti-tubercular treatment and suffered from pyogenic abscess over back, and rectal area, around the umbilical area. Pus culture isolated coagulase-negative Staphylococcus. In due course of time, the patient took treatment but abscess continued to develop over different parts of the body. This is a suspected case of tuberculous gumma based on clinical presentation and history of the disease, and according to Ayurveda, this is a case of Dushi-visha. The classical treatment of an abscess is focussed on incision and drainage, but this case was handled with Vishaghna chikitsa (~anti-toxin treatment) and other potential treatments considering the resurgence of Dushi-visha without any surgical intervention. Many conditions, which generally seem idiopathic due to lack of proper history, may be due to reactivation of Dushi-visha. This case report opens up the way to clinically identify and potentially treat the condition with Ayurveda.