The Unclassical Manifestation of Tuberculosis: Mimicking Lung Metastasis and Cutaneous Lymphoma: Case Report
Shanaz Novriandina [1], Yana Akhmad [2], Risa Miliawati [3], Pramesti Indri [4], Prayudi Santoso [2]
[1] Department of Internal Medicine, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung
[2] Respirology and Critical Disease Division, Department of Internal Medicine, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung
[3] Department of Dermatology and Venereology, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung
[4] Department of Radiology, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung
Abstract
Background: Lung Tuberculosis (TB) may occur with atypical presentations and radiological findings that mimic lung metastasis and cutaneous lymphoma. Diagnostic challenges for atypical TB will increase the risk of delaying proper treatment, irrational use of broad-spectrum antibiotics, and continuing transmission of Mycobacterium tuberculosis (Mtb).
Case: A 57-year-old woman presented with a one-year history of a chronic non-healing ulcer over the axilla and inguinal regions, along with multiple discharging sinuses and surrounding induration. The lesions were initially described as bacterial abscesses or hidradenitis suppurativa. She was repeatedly given a systemic antibiotic and a topical corticosteroid over two months. However, her condition deteriorated and was complicated by secondary infection. Xpert Mtb/RIFon sputum and pus detected rifampicin-sensitive Mtb, and a skin biopsy revealed features consistent with scrofuloderma. A diagnosis of disseminated TB was established, and she started on anti-tuberculosis treatment and showed clinical improvement after four weeks.
Discussion: The delayed diagnosis of disseminated TB mimicking lung metastasis and cutaneous lymphoma resulted in delayed treatment of anti-tuberculosis and progressive worsening of clinical symptoms. The diagnosis was made based on Xpert Mtb/RIFon sputum and pus in the wound base, thoracic CT scan, and skin biopsy. The patient was started on anti-tuberculosis therapy and showed clinical improvement after four weeks of treatment.
Conclusion: Chronic ulcers that have worsened despite systemic broad-spectrum antibiotics should be considered as cutaneous tuberculosis. Scrofuloderma, the most common cutaneous tuberculosis, is one of the markers of disseminated TB. It requires assessment to confirm pulmonary and extrapulmonary TB.
Keywords: Scrofuloderma; lung tuberculosis; disseminated tuberculosis; lung metastasis
