PMC4430640_01
Clinical manifestation of cutaneous tuberculosis involving the right infraclavicular region and showing three lesions, one nodular and the others ulcerated.
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On her physical examination she presented with three skin lesions (two ulcerated and one nodular) involving the right subclavicle region and other two lesions on her left thigh (one ulcerated and the other in a healing phase) (Figures 1 and 2); her neurological exams exhibited an ASIA A paraplegia with a sensory level at D4.
((a) and (b)) Clinical manifestation of cutaneous tuberculosis involving the left thigh and showing two lesions, one ulcerated (a) and the other in a healing phase (b).
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On her physical examination she presented with three skin lesions (two ulcerated and one nodular) involving the right subclavicle region and other two lesions on her left thigh (one ulcerated and the other in a healing phase) (Figures 1 and 2); her neurological exams exhibited an ASIA A paraplegia with a sensory level at D4.
Chest X-ray showing enlargement of the mediastinum, consistent with tuberculous abscess mass.
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A chest X-ray revealed an enlarged mediastinal shadow (Figure 3), and the spinal computed tomographic scan showed a large anterior and paravertebral abscess from D1 to D10 with significant compression and osteolytic lesions of vertebral bodies with a kyphotic deformity (Figure 4).
CT showing osteolytic lesions involving several vertebral bodies with severe kyphotic deformity, due to the collapse of the anterior spinal elements.
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A chest X-ray revealed an enlarged mediastinal shadow (Figure 3), and the spinal computed tomographic scan showed a large anterior and paravertebral abscess from D1 to D10 with significant compression and osteolytic lesions of vertebral bodies with a kyphotic deformity (Figure 4).
MRI with gadolinium showing a paravertebral abscess.
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Spinal magnetic resonance revealed significant compression of the spinal cord at the kyphotic apex and angulation of the column, anterior and paravertebral epidural abscess consistent with spondylodiscitis (Figure 5).
Histologic picture of the skin biopsy of one thigh lesion, showing pseudoepitheliomatous hyperplasia with suppurative granulomas.
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Skin biopsy of the lesions (Figure 6) revealed acanthosis and pseudoepitheliomatous, hyperplasia of the epidermis, and necrosis foci surrounded by a histiocytic and lymphocyte infiltrate with giant cells on the dermis, consistent with tuberculosis with negative Ziehl-Neelsen stain.