A clinicopathological pattern of cutaneous tuberculosis and HIV concurrence in western Rajasthan.

Background: Cutaneous tuberculosis (TB) forms a small subset of extrapulmonary TB and continues to be a significant diagnostic dilemma in routine practice. The present study is an attempt to find the incidence, clinical spectrum, and histopathological features of cutaneous TB in western Rajasthan. The relation of cutaneous TB with the human immunodeficiency virus (HIV) was also assessed.

Method: A total of 40 cases of newly diagnosed patients of cutaneous TB attending the dermatology outpatient department over a period of 1 year were included in the study. A detailed clinical examination and investigations including histopathological examination were carried out.

Results: The overall incidence of cutaneous TB was 0.025% (40 of 160,000 outpatients). HIV concurrence was 5% (2 cases) of all cutaneous TB cases. The most common variants were scrofuloderma (40%), lupus vulgaris (30%), TB verrucosa cutis (8%), orificial TB (2%), and lichen scrofulosorum (2%). Males suffered more than females (2.07:1) and all patients belonged to lower socioeconomic class. The Mantoux test was positive in 65% of cases. Extracutaneous involvement occurred in 17 (42.50%) cases. Characteristic well-defined tuberculoid granulomas were seen in 60% of cases, whereas 40% of cases showed nonspecific changes.

Conclusion: : This study provides the epidemiological data of cutaneous TB in western Rajasthan, identifies the clinicohistopathological pattern, and calls the attention of the health-care professionals that they should improve the propaedeutics of neglected and underdiagnosed cases of cutaneous TB that is prevalent in the lower socioeconomic group. Due to the varied clinical presentations, physician awareness and a high index of suspicion are necessary to diagnose cutaneous forms of TB.