Ann Dermatol.  2017 Feb;29(1):95-99. 10.5021/ad.2017.29.1.95.

Multiple Skin Colored Nodules on both Legs in Patient with Positive QuantiFERON®-TB Gold Test

• Choi MS
• Hong SP
• Park BC
• Kim MH

• KMID: 2368036
• DOI: http://doi.org/10.5021/ad.2017.29.1.95

Abstract

Nodular tuberculid (NT) was originally described by Jordaan et al. in 2000 in 4 patients from South Africa. It appeared as nodules on the legs; the pathologic changes were situated in the deep dermis and adjacent subcutaneous fat. A 34-year-old woman visited our hospital with subcutaneous skin-colored or slightly erythematous round to oval nodules. Skin biopsies revealed granulomatous inflammation at the dermo-subcutaneous junction with vasculitis. Chest X-ray, tuberculosus (TB)-polymerase chain reaction and TB culture of the skin specimen were normal. A QuantiFERON®-TB Gold test (QUIAGEN, Germany) was positive, which suggested a diagnosis of latent TB infection. The patient was treated with anti-TB medication and her condition has not recurred. Herein, we report a case of a patient with latent TB diagnosed by a positive QuantiFERON®-TB Gold test whose skin lesions had the clinical and histopathologic features of NT.

Keyword

Nodular tuberculid; QuantiFERON®-TB Gold test; Tuberculid

MeSH Terms

Adult
Biopsy
Dermis
Diagnosis
Female
Humans
Inflammation
Leg*
Skin Pigmentation*
Skin*
South Africa
Subcutaneous Fat
Thorax
Tuberculosis, Cutaneous
Vasculitis

Figure

• 

  Fig. 1 Multiple tender skin-colored to slightly erythematous round to oval subcutaneous nodules.

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  Fig. 2 Granulomatous inflammation at the dermo-subcutaneous junction (H&E, ×40).

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  Fig. 3 Dense inflammatory cell infiltration around the vessels. Multinucleated giant cells, eosinophils, lymphocytes, foamy histiocytes, and neutrophils are evident (H&E, ×200).

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  Fig. 4 Caseous necrosis in the superficial subcutaneous layer (H&E, ×100).

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