Tuberculids as sentinel lesions of tuberculous epididymo-orchitis
Article first published online: 26 JAN 2007
Journal of Cutaneous Pathology
Volume 34, Issue 11, pages 830–836, November 2007
How to Cite
Ramdial, P. K., Calonje, E., Sydney, C., Subrayen, S., Meyiwa, P. S. and Aboobaker, J. (2007), Tuberculids as sentinel lesions of tuberculous epididymo-orchitis. Journal of Cutaneous Pathology, 34: 830–836. doi: 10.1111/j.1600-0560.2007.00716.x
- Issue published online: 26 JAN 2007
- Article first published online: 26 JAN 2007
- Accepted for publication November 28, 2006
Background: Tuberculids are rarely associated with male genital tract tuberculosis (TB). Tuberculous epididymo-orchitis (TBEO) has been associated rarely with papulonecrotic tuberculid (PNT) but not with erythema induratum (EI) or the simultaneous occurrence of different tuberculids.
Methods: A retrospective assessment of tuberculids that occurred with underlying TBEO was carried out.
Results: Five patients, four with one and one with two skin biopsies, with clinical diagnoses of PNT (two), EI (one), impetigo (two) and calf ulcer (one), formed the study cohort. Histopathological evaluation confirmed PNT and EI in four and two skin biopsies, respectively. Two patients who returned for follow-up were commenced on anti-tuberculous therapy. All patients sought medical attention 3–34 months later for tender right-sided (two) and left-sided (three) testicular masses. Orchidectomy was undertaken following a poor clinical response to empirical treatment with trimethoprim sulfamethoxazole. Pathological examination of the testis and epididymis confirmed TBEO. The patients were initiated on anti-tuberculous therapy. There was dramatic healing of the skin lesions.
Conclusion: Tuberculids are a sentinel cutaneous manifestation of visceral TB and a valuable external audit of treatment compliance and response. Heightened recognition of and more rigorous genitourinary tract investigation are necessary to identify occult or asymptomatic TBEO as the underlying cause of tuberculids.