Tuberculous gummas: Epidemiological, clinical, bacteriological, immunological, and therapeutic features

Abstract

Tuberculous gummas are an unusual form of tuberculosis (TB) accounting for 1%–2% of all cutaneous TB cases. The aim of this article was to describe the epidemiological, clinical, bacteriological, immunological, and therapeutic features of this form upon a case report and a literature review. Forty-eight case reports were identified through a PubMed and Google Scholar search using the following keywords: “tuberculous gumma” and “metastatic tuberculous abscesse.” Tuberculous gumma can occur at any age. Immunodepression is not a sine qua non condition to the development of the disease. Limbs are the most frequent site for gummas. Tuberculous gummas are associated to another location in only 73% of cases. The most frequent associated locations are lung, nodes, and musculoskeletal apparatus. Mantoux test is negative in 38% of cases. Skin stain is positive in 45% of cases and culture in 85% of cases. Giant epithelioid cell granuloma is present in 82.4% of cases. There is no universally accepted chemotherapy regimen for metastatic tuberculous abscesses. The classic 2RHZE/4RH is highly effective.

Keywords

• Cutaneous tuberculosis
• metastatic tuberculous abscesses
• multifocal tuberculosis
• tuberculous gumma