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CASE REPORT
  
Year : 1991  |  Volume : 57  |  Issue : 6  |  Page : 303-304

Cutaneous tuberculosis with leprosy

J Pinto, GS Pal, N Kamath 
 

Correspondence Address:
J Pinto


Abstract

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.



How to cite this article:
Pinto J, Pal G S, Kamath N. Cutaneous tuberculosis with leprosy.Indian J Dermatol Venereol Leprol 1991;57:303-304


How to cite this URL:
Pinto J, Pal G S, Kamath N. Cutaneous tuberculosis with leprosy. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2020 Mar 28 ];57:303-304
Available from: http://www.ijdvl.com/text.asp?1991/57/6/303/3715


Full Text

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.[1],[2]

 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. [3] The reported incidence of tuberculosis in leprosy patients in India varies from 2.5 7.7% [4].

Tuberculosis can occur throughout the leprosy spectrum and persons suffering from leprosy have increased susceptibility to tuber­culosis. [5]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. [4] But this immune status does not pre­dispose to any other mycobacteria infection. [2]

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. [6]

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. [7] Many reports including the present case report militate against the cross immunity between the two bacteria. [1],[2],[3],[4],[5],[6]

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. [6]

References

1Ganapati R, Deshpande D H and Chulawala R G; Some interesting disease combinations - Report on two cases, Leprosy in India, 1976; 48 : 428.
2Patki A H, Jadhav V H and Mehta J M : Leprosy and multicentric lupus vulgaris, Ind J Leprosy, 1990; 62 : 368-70.
3Desikan K V and Job C K; A review of post mortem findings in 37 cases of leprosy, Internal: J Leprosy, 1968; 36 : 32.
4Mohan Singh, Kaur S, Kumar 'I at al : The asso­ciated diseases with leprosy, Ind J Leprosy, 1987; 59 : 315-321.
5Nigam P, Dubey AL, Dayal S G et al : The asso­ciation of leprosy and pulmonary tuberculosis, Leprosy in India, 1979; 51 : 65-73.
6Gupta M C and Prasad M : Associated infection of Pulmonary Tuberculosis and Leprosy, Ind J Med Sci, 1971; 25 : 183.
7Hayashi F.: Mitsuda's skin reaction.in Leprosy, Intemat J Leprosy, 1933; 1 : 31.

 

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