Cutaneous miliary tuberculosis in a patient infected with human immunodeficiency virus.
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Light and scanning electron microscopic study of tissues obtained at biopsy and at autopsy from a 64-year-old male drug addict revealed the presence of foreign body granulomas associated with birefringent crystals in the lungs, liver, bone marrow, spleen, and lymph nodes. Caseating granulomas associated with Mycobacteriaceae tuberculosis were also present. Energy dispersive X-ray analysis identified the crystals as talc. Minute talc crystals were also visualized in urine sediment, by scanning electron microscopy and identified by energy dispersive X-ray analysis.
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A 38-year-old patient with chronic alcoholism was on chemotherapy for acute myelomonocytic leukemia and developed purpuric and erythematous papules. Skin biopsy showed a vasculitis. Subsequent autopsy revealed disseminated tuberculosis with a poor cellular response. This case calls attention to the lack of tuberculoid granulomatous reaction is anergic patients and to the need of pathologists to suspect tuberculosis when necrotizing vasculitis in the skin is encountered in a patient with decreased immunological competence.
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Cutaneous involvement is an unusual presentation of tuberculosis (TB) and is rarely reported in renal transplant recipients. We describe a 37-year-old renal transplant recipient with disseminated Mycobacterium tuberculosis infection that presented as cellulitis. The organism was isolated from tissue and blood cultures. The patient was treated with quadruple anti-TB therapy for 12 months. Anti-TB therapy led to a complete resolution of TB lesions. We also provide a review of the literature on cutaneous TB in renal transplant recipients. Skin TB in renal transplant recipients usually occurs with nontuberculous mycobacteria. The spectrum of the skin lesions can be quite different and can mimic bacterial infections. Mycobacteriosis should always be included in the differential diagnosis of a skin lesion in renal transplant recipients.
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