Papulonecrotic tuberculid in children: A report of eight patients

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dc.contributor.authorJordaan H.F.
dc.contributor.authorSchneider J.W.
dc.contributor.authorSchaaf H.S.
dc.contributor.authorVictor T.S.
dc.contributor.authorGeiger D.H.
dc.contributor.authorVan Helden P.D.
dc.contributor.authorRossouw D.J.
dc.date.accessioned2011-05-15T16:15:19Z
dc.date.available2011-05-15T16:15:19Z
dc.date.issued1996
dc.description.abstractPapulonecrotic tuberculid (PNT), a form of cutaneous tuberculosis (TB), is uncommon in children. We identified eight children (six girls and two boys) with PNT. Their ages ranged from 19 to 139 months (median: 47.5 months, mean: 64.75 months). Skin lesions had been present for 2-24 weeks (median: 4 weeks) before diagnosis. All patients displayed scattered papulo- and/or pustulonecrotic lesions on the limbs, and the ears were involved in six patients. Lesions healed with varioliform scars. Associated pulmonary TB was present in seven patients. Additional clinical findings included fever (n = 4), hepatomegaly (n = 4), lymphadenopathy (n = 3), phlyctenular conjunctivitis (n = 3), and splenomegaly (n = 2). Histology of eight biopsies showed ulceration (n = 6), dermal necrosis (n = 6) (follicle-centered in two), granulomatous inflammation (n = 6) (palisading granuloma-like in three), superficial and deep (infiltrate of lymphocytes (n = 7), erythrocyte extravasation (n = 7), and subepidermal edema (n = 3). Vasculitis was not a feature. A Ziehl-Neelsen stain was negative in all. Glycosaminoglycans were not increased. Immunohistochemistry found a predominance of T lymphocytes, macrophages, a few antigen-presenting cells, and no B lymphocytes, consistent with a type IV hypersensitivity reaction. Polymerase chain reaction (PCR) performed on deparaffinized tissue identified M. tuberculosis DNA in one biopsy. All patients received combination anti-TB treatment for 6 months. Six patients were compliant and were followed up for 6-30 months. Skin lesions and pulmonary TB healed in all. PNT in children resembles the adult form, but phlyctenular conjunctivitis and associated TB are more common, scrofuloderma and concomitant erythema induratum of Bazin are unusual, and vasculitis is not found. In cases where M. tuberculosis DNA can be confirmed with PCR, papulonecrotic TB is perhaps the more appropriate nomenclature.
dc.description.versionArticle
dc.identifier.citationAmerican Journal of Dermatopathology
dc.identifier.citation18
dc.identifier.citation2
dc.identifier.issn01931091
dc.identifier.other10.1097/00000372-199604000-00011
dc.identifier.urihttp://hdl.handle.net/10019.1/13282
dc.subjectethambutol
dc.subjectglycosaminoglycan
dc.subjectisoniazid
dc.subjectpyrazinamide
dc.subjectrifampicin
dc.subjectrifater
dc.subjecttuberculostatic agent
dc.subjectarticle
dc.subjectchild
dc.subjectclinical article
dc.subjectconjunctivitis
dc.subjectfemale
dc.subjectfever
dc.subjectgranulomatous inflammation
dc.subjecthepatosplenomegaly
dc.subjecthuman
dc.subjecthuman tissue
dc.subjecthypersensitivity
dc.subjectlung tuberculosis
dc.subjectlymphadenopathy
dc.subjectlymphocytic infiltration
dc.subjectmale
dc.subjectpapule
dc.subjectpapulonecrotic tuberculid
dc.subjectpolymerase chain reaction
dc.subjectpriority journal
dc.subjectpustule
dc.subjectscar
dc.subjectskin edema
dc.subjectskin necrosis
dc.subjectskin tuberculosis
dc.subjectskin ulcer
dc.subjectAdult
dc.subjectAntitubercular Agents
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectCicatrix
dc.subjectConjunctivitis
dc.subjectErythrocytes
dc.subjectFemale
dc.subjectFever
dc.subjectFollow-Up Studies
dc.subjectGranuloma
dc.subjectHepatomegaly
dc.subjectHumans
dc.subjectHypersensitivity, Delayed
dc.subjectInfant
dc.subjectLymphatic Diseases
dc.subjectLymphocytes
dc.subjectMacrophages
dc.subjectMale
dc.subjectNecrosis
dc.subjectSkin Ulcer
dc.subjectT-Lymphocytes
dc.subjectTuberculosis, Cutaneous
dc.subjectWound Healing
dc.titlePapulonecrotic tuberculid in children: A report of eight patients
dc.typeArticle
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