Managing Cutaneous Tuberculosis: A Case Report

Tuberculosis (TB) continues to be a prevalent disease worldwide; an estimated one third of the world's population is infected and 2015 data from the World Health Organization show 10 million people had an active infection. Although TB often is cited as a disease that most commonly occurs in underdeveloped countries, the evolution of drug-resistant forms of TB and infection sensitivity of immunocompromised individuals have made this disease a focal point for industrialized countries as well. When TB is spread, it commonly affects the lungs, but it can infect any organ of the body. An uncommon version - cutaneous TB - affects <2% of all individuals with an active form of TB. This study describes a 34-year-old man with multiple comorbidities, including peripheral vascular disease and a remote history of travel to Latin America who presented to a wound care clinic with a 2-year history of painful shallow necrotic ulcers on his right lower limb and previous treatments that included a positive response to antibiotics. Once TB was confirmed via 2 positive Quantiferon Gold tests, the patient received therapy (directly observed by the state health department) that included pyrazinamide, rifampin, ethambutol, isoniazid, and undocumented vitamin B-6. Treatment for the TB-related lesions, concomitant cellulitis, and a Stage 2 pressure injury under his first right metatarsal head was initiated as well. The patient received local wound care for 40 days that included sharp debridement, of floading for the pressure injury, and pain relief before treatment at the wound care clinic and daily as prescribed by his primary care provider. All wounds were securely covered with collagen dressings followed by silicone-bordered bandages. Local wound care was provided for 40 days, with biweekly follow-up for an additional 30 days. The wounds resolved and the patient was discharged from the wound care clinic but remained on the caseload for 30 days in the event his pain increased or the wounds recurred. Cutaneous TB, uncommon and challenging, should be a consideration in patients with an increased likelihood of occurrence.