|Year : 1991 | Volume
| Issue : 6 | Page : 303-304
Cutaneous tuberculosis with leprosy
J Pinto, GS Pal, N Kamath
Source of Support: None, Conflict of Interest: None
The association of cutaneous tuberculosis with leprosy has been reported rarely. Though both the diseases are caused by mycobacteriae, no true antagonism exists. This case report confirms the above view.
Keywords: Cutaneous tuberculosis, Leprosy
|How to cite this article:|
Pinto J, Pal G S, Kamath N. Cutaneous tuberculosis with leprosy. Indian J Dermatol Venereol Leprol 1991;57:303-4
Though many patients with pulmonary tuberculosis and leprosy have been reported in the literature, the association of cutaneous tuberculosis with leprosy has been reported rarely.,
| Case Report|| |
A 36-year-old male presented with warty, slowly growing lesion on the right sole of sixteen years duration and whitish patches on the body of four years duration. The warty lesion occurred after a thorn prick. He did not give a past history suggestive of pulmonary tuberculosis.
Examination revealed right inguinal lymphadenopathy with discrete, firm, mobile and non-tender lymph nodes. Right pedal pitting oedema was elicited. Cutaneous examination revealed a large, warty lesion on the distal half of the right sole extending to the instep with deep fissures. The surrounding skin was normal. [Figure - 1]
Erythematous plaques four in number were present on the shoulders and right forearm, [Figure - 2]. The borders of the plaques were well defined in places and were anaesthetic. He had thickened right lateral popliteal nerve with right foot drop. Sputum for AFB and skin smear for AFB were negative. X-Ray chest and Mantoux test were normal.
A biopsy from the warty lesion revealed marked hyperkeratosis, papillomatosis with epithelioid granulomas in the papillary and middermis with Langhan's giant cells. Dermis showed moderate lymphocytic infiltrate. A diagnosis of tuberculosis verrucosa cutis was made. Biopsy of the erythematous plaque showed borderline tuberculoid leprosy. Patient was put on anti-tuberculosis and anti leprosy treatment. This was however stopped as the patient developed jaundice.
| Comments|| |
Pulmonary tuberculosis can be associated with leprosy. It was the cause of death in 10 out of 37 patients.  The reported incidence of tuberculosis in leprosy patients in India varies from 2.5 7.7% .
Tuberculosis can occur throughout the leprosy spectrum and persons suffering from leprosy have increased susceptibility to tuberculosis. sub This has not been definitely proved but may be due to reasons like devitalization, poor nutrition etc. Leprosy spectrum demonstrates immunocompetent TT, immunosuppressed LL and immuno labile Borderline group.  But this immune status does not predispose to any other mycobacteria infection. 
Prevalence of association of leprosy and tuberculosis will vary with the individual susceptibility to both the diseases. It is recognized that there is a close antigenic relationship between M. tuberculosis and M. leprae. 
In the general population, infection with tuberculosis does not always give rise to a positive lepromin test and lepromin sensitivity may exist in the absence of tuberculosis infection. There is a complete disassociation of tuberculin and lepromin tests in leprosy patients.  Many reports including the present case report militate against the cross immunity between the two bacteria. ,,,,,
In our report, the cutaneous tuberculosis may be a normal sequel to M. tuberculosis inoculation into the sole. The borderline tuberculoid leprosy is a second mycobacteria infection. Clinically there is no absolute antagonism between the two infections. If at all, antagonism may at best be partial. If host resistance is poor, the two diseases coexist. 
| References|| |
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[Figure - 1], [Figure - 2]