Tuberculous gumma

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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W8MD medical weight loss NYC and sleep center NYC

Tuberculous gumma
Synonyms	Metastatic tuberculous abscess
Pronounce	N/A
Specialty	N/A
Symptoms	Skin lesion, ulcer, abscess
Complications	Scarring, secondary infection
Onset	Variable
Duration	Chronic
Types	N/A
Causes	Mycobacterium tuberculosis
Risks	Immunocompromised state, HIV/AIDS, malnutrition
Diagnosis	Biopsy, culture, PCR
Differential diagnosis	Sporotrichosis, cutaneous leishmaniasis, syphilis
Prevention	BCG vaccine, tuberculosis control
Treatment	Antitubercular therapy
Medication	Isoniazid, rifampicin, ethambutol, pyrazinamide
Prognosis	Good with treatment
Frequency	Rare
Deaths	Rare with treatment

A rare form of cutaneous tuberculosis

Tuberculous gumma, also known as metastatic tuberculous abscess, is a rare form of cutaneous tuberculosis. It is characterized by the formation of soft, tumor-like masses on the skin, which are caused by the hematogenous spread of Mycobacterium tuberculosis from a primary focus elsewhere in the body.

Pathophysiology

Tuberculous gumma occurs when Mycobacterium tuberculosis bacteria spread through the bloodstream and form abscesses in the skin. This condition is more likely to occur in individuals with a compromised immune system, such as those with HIV/AIDS or those undergoing immunosuppressive therapy. The bacteria can form nodules that eventually ulcerate, leading to the characteristic lesions of tuberculous gumma.

Clinical Presentation

Patients with tuberculous gumma typically present with painless, firm nodules on the skin. These nodules can vary in size and may become ulcerated over time. The lesions are often found on the extremities, but can occur anywhere on the body. The skin overlying the nodules may appear normal or erythematous.

Diagnosis

The diagnosis of tuberculous gumma is confirmed through a combination of clinical examination, skin biopsy, and microbiological studies. A biopsy of the lesion typically shows caseating granulomas, which are indicative of tuberculosis. Polymerase chain reaction (PCR) and culture of the biopsy material can be used to identify Mycobacterium tuberculosis.

Treatment

The treatment of tuberculous gumma involves the use of antitubercular therapy. The standard regimen includes a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide for an initial period, followed by isoniazid and rifampicin for a continuation phase. The duration of treatment is typically 6 to 12 months, depending on the severity of the disease and the patient's response to therapy.

Prognosis

With appropriate treatment, the prognosis for patients with tuberculous gumma is generally good. The lesions usually resolve with antitubercular therapy, although scarring may occur. Early diagnosis and treatment are crucial to prevent complications and the spread of the disease.

See also

• Tuberculosis
• Cutaneous tuberculosis
• Mycobacterium tuberculosis
• Granuloma