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    A 75 Year Old Woman Presenting With Nasal Vestibulitis

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    Yosephine Nina Widyarini
    jurnal vesitbulitis

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    A 75 Year Old Woman Presenting With Nasal Vestibulitis

    Uploaded by

    Yosephine Nina Widyarini
    24 views2 pages
    jurnal vesitbulitis

    Original Title

    Saracino 2017

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    jurnal vesitbulitis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views2 pages

    A 75 Year Old Woman Presenting With Nasal Vestibulitis

    Uploaded by

    Yosephine Nina Widyarini
    jurnal vesitbulitis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Infection

    DOI 10.1007/s15010-017-1087-z

    IMAGES IN INFECTION

    A 75‑year‑old woman presenting with nasal vestibulitis


    Annalisa Saracino1   · Francesco Fortarezza2 · Danila Costa3 · Domenico Bonamonte4 

    Received: 20 February 2017 / Accepted: 21 October 2017


    © Springer-Verlag GmbH Germany 2017

    An Italian diabetic 75-year-old woman presented with Ziehl–Neelsen staining was negative. TST resulted in 10 mm
    nasal vestibulitis, which had worsened in the preceding induration; QuantiferonTB Gold Test was undetermined;
    20 months despite multiple antibiotic cycles. No fever or microscopic examination yielded negative results. No pre-
    systemic symptoms were reported. Dermatological exami- vious tuberculosis (TB) or TB contact was reported. A total
    nation revealed infiltrative dermatitis of the nose on both body CT scan excluded the involvement of other organs.
    alar-sidewalls and apex, also extending to right cheek. The Isoniazid, rifampin, ethambutol and claritromycin were ini-
    skin was reddish-brown, slightly desquamating, swollen tiated, to take into account non-tuberculous mycobacteria.
    and infiltrated upon palpation (Fig. 1a, b). A diascopy was One month later, M. tuberculosis (fully susceptible to all
    carried out, pressing a pocket hand lens on the lesion, thus antitubercular drugs) was isolated, then claritromycin was
    provoking a momentary ischemia, resulting in a yellow- interrupted. A 6-month regimen is recommended for cutane-
    ish color at the periphery. Infection was spreading to nasal ous TB (lupus vulgaris) treatment [1], which was sufficient
    mucosa, where crusting mucoid rhinorrhea and mild airway in our patient to obtain a complete resolution.
    obstruction were observed. Laboratory exams and chest Cutaneous tuberculosis, which represents < 1–2% of all
    X-ray images were normal. cases of extra-pulmonary TB, is scarcely known by physi-
    A biopsy of nasal vestibule was performed (Fig.  1c, cians in areas with low prevalence, also because of the huge
    d). Histopathological analysis revealed multiple granu- variety of clinical presentations, often leading to treatment
    lomatous tubercles composed of epithelioid cells, giant delay [2, 3].
    (Langhans) cells, and lymphocytes, with caseous necrosis.

    * Annalisa Saracino
    annalisa.saracino@uniba.it
    1
    Department of Biomedical Science and Human Oncology,
    Clinic of Infectious Diseases, University of Bari, 11, Piazza
    Giulio Cesare, Bari 70124, Italy
    2
    Section of Pathological Anatomy, Department of Emergency
    and Organ Transplantation, University of Bari, Bari, Italy
    3
    Mycobacteria Laboratory, Microbiology and Virology Unit,
    University Hospital, Policlinico, Bari, Italy
    4
    Section of Dermatology, Department of Biomedical Science
    and Human Oncology, University of Bari, Bari, Italy

    13
    Vol.:(0123456789)
    A. Saracino et al.

    Fig. 1  Infiltrative dermatitis of nose (a) and right cheek (b) and his- of epithelioid cells, giant cells (Langhans type) (black arrows), and
    topathological examination of a biopsy specimen obtained from the lymphocytes (yellow arrows), with central caseous necrosis (white
    nasal vestibule, hematoxylin and eosin stain, ×40 magnification (c) arrows) is showed (hematoxylin and eosin stain)
    and ×100 magnification (d). A granulomatous infiltrate composed

    Compliance with ethical standards  2. Bravo FG, Gotuzzo E. Cutaneous tuberculosis. Clin Dermatol.
    2007;25:173–80.
    3. Van Zyl L, du Plessis J, Viljoen J. Cutaneous tuberculo-
    Ethical standards  The patient provided a written consent for the use
    sis overview and current treatment regimens. Tuberculosis.
    of her clinical data for scientific purposes.
    2015;95:629–38.

    Conflict of interest  The authors declare that they have no conflict


    of interest.

    References

    1. Barbagallo J, Tager P, Ingleton R, Hirsch RJ, Weinberg JM. Cuta-


    neous tuberculosis: diagnosis and treatment. Am J Clin Dermatol.
    2002;3:319–28.

    13

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