{"doi":"10.1016/j.jdin.2023.08.003","title":"Cutaneous tuberculosis: A multi-institution cohort study from 2 academic medical centers in the United States","abstract":"To the Editor: Cutaneous involvement by tuberculosis (TB) occurs in 1% to 2% of patients with TB and is rare in the United States.1Sethuraman G. Ramesh V. Cutaneous tuberculosis in children.Pediatr Dermatol. 2013; 30: 7-16https://doi.org/10.1111/j.1525-1470.2012.01794.xCrossref PubMed Scopus (45) Google Scholar,2Machan A. Hanafi T. Hjira N. Boui M. Tuberculous gummas: epidemiological, clinical, bacteriological, immunological, and therapeutic features.Int J Mycobacteriol. 2018; 7: 203-211https://doi.org/10.4103/ijmy.ijmy_83_18Crossref PubMed Scopus (8) Google Scholar This study aims to characterize the clinical presentation and treatment course of cutaneous TB at 2 US academic medical centers. Patients diagnosed with cutaneous TB from January 2011 to May 2020 at Mass General Brigham and University of California San Francisco Health were identified by searching electronic medical record systems for terms related to cutaneous TB, yielding 743 cases (Supplementary Appendix 1, available via https://data.mendeley.com/datasets/m7rgh7c27g/1). These were screened for the inclusion criteria, which consisted of the history of TB or any positive TB test with concerning skin findings for tuberculosis, tuberculid, and/or receipt of anti-TB therapy to treat a cutaneous process, yielding 18 cases with complete follow-ups (Fig 1). After excluding 10 cases with alternative diagnoses (putative tuberculids and nonspecific neutrophilic dermatoses), 8 cases with a final clinical diagnosis of cutaneous TB remained. Seven patients (88%) were Asian, whereas the remaining patients were of unspecified race (Table I). Their ages ranged between 22 and 74 years, with 50% of them being females. All 8 patients were born outside the United States. Two patients (25%) were on immunosuppressive medications. Morphologies included subcutaneous nodules and erythematous-to-violaceous plaques with variable ulceration and surrounding erythema. Four patients (50%) had cutaneous TB secondary to pulmonary or systemic TB, whereas the remaining 4 had primary cutaneous disease or TB of unknown origin. The subtypes included 4 cases of scrofuloderma, 2 of lupus vulgaris, and 2 of acute miliary TB.3Kaul S, Kaur I, Mehta S, Singal A. Cutaneous tuberculosis. Part I: Pathogenesis, classification, and clinical features. J Am Acad Dermatol. 2022:S0190-9622(22)00202-X. https://doi.org/10.1016/j.jaad.2021.12.063Google Scholar Seven patients had skin biopsies, all demonstrating granulomatous and suppurative inflammation, consistent with atypical infection. Six of them had Fite stains, and all were negative for mycobacteria. Acid-fast bacilli (AFB) smear from skin was positive in 1 out of 6 cases. Mycobacterium TB growth was noted in skin tissue cultures in 3 out of 6 cases (50%). Interferon-gamma release assay (IGRA) was positive in 4 out of 6 cases (67%), tuberculin skin test was positive in 4 out of 6 cases (67%), and both tests were positive in 3 out of 3 cases (100%). All patients were prescribed multidrug therapy, including rifampin, isoniazid, and pyrazinamide, and in 7 out of 8 cases, ethambutol was also prescribed. Six patients had relevant follow-up, with 5 (83%) demonstrating partial or complete dermatologic improvement by 16 weeks, 3 of whom had responded by 10 weeks. The remaining patient demonstrated no dermatologic response, despite a history of TB, positive sputum culture, and histology consistent with cutaneous TB.Table IClinical presentation, diagnosis, and response to treatmentPatientAge (y)SexRaceSubtypeDistributionTSTIGRAAFB smearAFB cultureResponse to treatment125FemaleAsianScrofulodermaHead & NeckNegativePositiveNegativePositivePartial253MaleAsianLupus vulgarisButtocksNegativePositiveNegativeNegativeUnavailable328MaleAsianScrofulodermaHead & Neck, trunkPositiveUnavailableUnavailableNegativeUnavailable461FemaleAsianAcute miliary tuberculosisTrunk, ExtremitiesPositivePositiveNegativePositiveFull548MaleOtherScrofulodermaTrunkPositivePositiveNegativePositivePartial62","journal":"JAAD International","year":2023,"id":410283,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9592,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1144454,"name":"Rebecca Jacobson","orcid":"0009-0006-9411-7753","position":1,"is_corresponding":false},{"id":1144456,"name":"Shilpa Ghatnekar","orcid":"0000-0003-1268-4035","position":2,"is_corresponding":false},{"id":1144457,"name":"Azan Z. Virji","orcid":"0000-0002-6574-0726","position":3,"is_corresponding":false},{"id":312336,"name":"Brian S. Schwartz","orcid":"0000-0003-2852-6808","position":4,"is_corresponding":false},{"id":293009,"name":"Lianne S. Gensler","orcid":"0000-0001-6314-5336","position":5,"is_corresponding":false},{"id":1144458,"name":"Anna Haemel","orcid":"0009-0000-0400-9158","position":6,"is_corresponding":false},{"id":1144895,"name":"Jason E. Frangos","orcid":null,"position":7,"is_corresponding":false},{"id":1144455,"name":"Rodrigo A. Gutierrez","orcid":"0000-0001-7410-154X","position":0,"is_corresponding":true}],"reference_count":3,"raw_metadata":null,"created_at":"2026-07-19T01:21:35.071397Z","pmid":"37700805","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}