Misdiagnosis of 21 cases of cutaneous tuberculosis

e707004304

Misdiagnosis of 21 cases of cutaneous tuberculosis

Document code: B Article ID :1007-0931 (2007) 10-1X) 84-01 performance of diversity of skin tuberculosis, atypical symptoms,[link widoczny dla zalogowanych], early misdiagnosis. Hospital clinic from 1995 to 2006 a total of 27 cases, of which 21 cases outside the hospital misdiagnosed. Patients have to undergo a biopsy or PPD test, diagnosed with clinical features of cutaneous tuberculosis. Analysis of clinical data is as follows. 1 General clinical data of the 21 cases, 6 males and 15 females; age of l7 ~ 54 years, mean 39 years; the first medical consultation range from 2 weeks to 10 years, an average of 3.6 years; no tuberculosis history. 2 clinical manifestations of 21 cases were skin erythema, papules, nodules, ulcers and treatment. There was no fever, night sweats, weight loss, fatigue symptoms. 3 cases with itching, local pain in 4 cases. Lesion sites: 21 cases 8 cases of face, nasal tip in 1 case, 1 case of ear, right ear and neck in 1 case, 2 cases of hips, buttocks and perineum in 1 case, fossa in 1 case, 1 case of knee , the body repeatedly disseminated papular batch nodules in 1 case, both lower limbs in 4 cases. The smallest lesions (1X1.5) cm,[link widoczny dla zalogowanych], the largest (5X10) cm. The performance of various skin lesions, were scattered in erythema, papules, pale red or brown size miliary nodules, smooth surface without tenderness, most of the integration into the film. State clearly that the surface scales, some have ulcers, abscess, skin lesions and the formation of scar healing quality hardware. 3 auxiliary examination chest X-ray examination of 21 cases were negative. Routine blood testing, neutrophils increased in 5 cases, 16 cases of normal; PPD (tuberculin enhanced) test, 14 were positive, 15 cases of local tissue pathology, were 7 cases of tuberculosis-like nodules,[link widoczny dla zalogowanych], nodule nodules in 3 cases, no tuberculosis or tuberculosis-like nodules nodules in 5 cases. 4 Diagnosis and treatment of PPD test or by the local tissue pathology, clinical features and diagnosis. One unusual lupus in 18 cases, 2 cases were misdiagnosed as ringworm face, acne I patients, 1 case of subacute lupus erythematosus, 1 case of rosacea, facial eczema in 3 cases, 2 cases of eczema, ear, perineum, and buttocks 1 case of eczema, eczema hip 3, Waterloo eczema, 1 case of skin infection in 1 knee, papular rash in 1 case of necrotizing tuberculosis, variability vasculitis, folliculitis in 1. Hard erythema of both lower extremities in 3 cases misdiagnosed as erythema nodosum, right lower extremity with chronic ulcer chronic skin ulcers and 1 case of infection. The 2HRZ/THR (H: Remy closure, R: rifampin, z: Author: Fifth Hospital of Jinhua City, Zhejiang Jinhua 321000, pyrazinamide) or 6-_9HR the treatment,[link widoczny dla zalogowanych], cure. Discuss the current trends of TB skin in the event of major changes, to diversification, cutaneous tuberculosis is a rare, but there is a certain morbidity. Misdiagnosis of the disease in clinical high rate was reported as 77,7% of domestic .... To further enhance awareness of the disease, summarize the clinical features,[link widoczny dla zalogowanych], and explore its diagnostic method and reduce the rate of misdiagnosis of major significance. Different types of skin has its characteristics, such as young people face an unusual predilection of lupus, lupus nodules were applesauce color, no tenderness, with characteristic sense. Should be noted that with the ring lupus erythematosus and other identification. Necrosis of tuberculosis such as pimples rash occurs in the limbs, distribute, nodular lesions were corn-like papules size, central necrosis, surface crusting, depressed scar left after healing, repeated into a piece of blood vessel happened to be with allergic Yan identification. Hard red spot showed flexor surface of both lower extremities legs the size of the induration symmetry soybeans, ranging from a single or several, several weeks after the nodules increased, dark red, slightly higher than the skin, burning pain, the boundary is unclear, should be lower limbs skin infections in the differential. Misdiagnosis: (1) of the rare cutaneous tuberculosis, the incidence is low, clinicians lack of knowledge of cutaneous tuberculosis, easily overlooked in the diagnosis and treatment of disease. (2) diversity of clinical manifestations of cutaneous tuberculosis is not easy diagnosis. (3) medical history and physical examination is not detailed enough. (4) Check the O management in patients with neglect my skin delayed medical treatment. Improve the diagnosis rate of misdiagnosis, do not ignore the skin management inspections; do PPD test chest X-ray examination; clinicians should strengthen awareness of the disease, in the treatment process detailed history, careful physical examination; attention to the slow clinical course of the disease to be considered long lasting ; to strengthen TB control advocacy to improve health awareness, so that patients in a timely manner, take the initiative to seek medical attention. Of TB patients and their families pay attention to inspection of the skin, may be able to early detection of skin tuberculosis.