array:22 [
  "pii" => "S0365059622001817"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2021.11.004"
  "estado" => "S300"
  "fechaPublicacion" => "2022-11-01"
  "aid" => "609"
  "copyrightAnyo" => "2022"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:17 [
      "pii" => "S2666275222001928"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2022.09.005"
      "estado" => "S300"
      "fechaPublicacion" => "2022-11-01"
      "aid" => "609"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Dermatologia Tropical&#47;Infectoparasit&#225;ria</span>"
        "titulo" => "Tuberculose cut&#226;nea ulcerativa vulvar secund&#225;ria &#224; tuberculose do trato genital"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "786"
            "paginaFinal" => "788"
          ]
        ]
        "contieneResumen" => array:1 [
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1634
                "Ancho" => 2175
                "Tamanyo" => 1291363
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Granuloma com necrose caseosa e infiltrado linfoc&#237;tico &#40;Hematoxilina &#38; eosina&#44; 400&#215;&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Jiangfan Yu, Wenxia Huang, Guiying Zhang, Rong Xiao"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Jiangfan"
                "apellidos" => "Yu"
              ]
              1 => array:2 [
                "nombre" => "Wenxia"
                "apellidos" => "Huang"
              ]
              2 => array:2 [
                "nombre" => "Guiying"
                "apellidos" => "Zhang"
              ]
              3 => array:2 [
                "nombre" => "Rong"
                "apellidos" => "Xiao"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059622001817"
          "doi" => "10.1016/j.abd.2021.11.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622001817?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222001928?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009700000006/v4_202410140645/S2666275222001928/v4_202410140645/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0365059622001921"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2021.07.009"
    "estado" => "S300"
    "fechaPublicacion" => "2022-11-01"
    "aid" => "620"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>"
      "titulo" => "Dermoscopy of annular elastolytic giant cell granuloma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "789"
          "paginaFinal" => "791"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1160
              "Ancho" => 1675
              "Tamanyo" => 328936
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0115"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pink patches with erythematous border at the frontal implantation hair line&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Tiago Fernandes Gomes, Jos&#233; Carlos Cardoso, Victoria Guiote"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Tiago Fernandes"
              "apellidos" => "Gomes"
            ]
            1 => array:2 [
              "nombre" => "Jos&#233; Carlos"
              "apellidos" => "Cardoso"
            ]
            2 => array:2 [
              "nombre" => "Victoria"
              "apellidos" => "Guiote"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S266627522200203X"
        "doi" => "10.1016/j.abdp.2022.09.016"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S266627522200203X?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622001921?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009700000006/v2_202306261757/S0365059622001921/v2_202306261757/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0365059622002033"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2022.08.002"
    "estado" => "S300"
    "fechaPublicacion" => "2022-11-01"
    "aid" => "631"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Tropical&#47;Infectoparasitary Dermatology</span>"
      "titulo" => "Sexually-transmitted monkeypox&#58; report of two cases"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "783"
          "paginaFinal" => "785"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2035
              "Ancho" => 1341
              "Tamanyo" => 391720
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Monkeypox&#46; Three pustules with central umbilication on the shaft of the penis&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Paula Sian Lopes, Gabriela Roncada Haddad, H&#233;lio Amante Miot"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Paula Sian"
              "apellidos" => "Lopes"
            ]
            1 => array:2 [
              "nombre" => "Gabriela Roncada"
              "apellidos" => "Haddad"
            ]
            2 => array:2 [
              "nombre" => "H&#233;lio Amante"
              "apellidos" => "Miot"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275222002156"
        "doi" => "10.1016/j.abdp.2022.09.027"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222002156?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622002033?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009700000006/v2_202306261757/S0365059622002033/v2_202306261757/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Tropical&#47;Infectoparasitary Dermatology</span>"
    "titulo" => "Vulvar ulcerative cutaneous tuberculosis secondary to genital tract tuberculosis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "786"
        "paginaFinal" => "788"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Jiangfan Yu, Wenxia Huang, Guiying Zhang, Rong Xiao"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Jiangfan"
            "apellidos" => "Yu"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Wenxia"
            "apellidos" => "Huang"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Guiying"
            "apellidos" => "Zhang"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "Rong"
            "apellidos" => "Xiao"
            "email" => array:1 [
              0 => "xiaorong65@csu.edu.cn"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Department of Dermatology&#44; Second Xiangya Hospital of Central South University&#44; Changsha&#44; China"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Dermatology&#44; The Fifth People Hospital of Hainan Province&#44; China"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1634
            "Ancho" => 2175
            "Tamanyo" => 1291683
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin &#38; eosin&#44; &#215;400&#46; A granuloma with caseous necrosis and lymphocytic infiltration&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis &#40;TB&#41; is a public health concern caused by infection with <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>&#44; typically affecting the lungs &#40;80&#37;&#41; and less than 1&#37; is cutaneous TB &#40;CTB&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The clinical appearance of CTB is quite varied&#44; the most predominant form is lupus vulgaris&#44; while ulcerative lesions are rare&#44; constituting 2&#37; of CTB cases&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> CTB is often misdiagnosed and missed in daily work&#46; In this report&#44; the authors introduce a rare case of vulvar ulcerative CTB secondary to genital TB and review the relevant literature&#46; A 29-year-old female patient presented with a vulvar ulcer for 10 months&#46; Since the second child was delivered by cesarean section&#44; her menstruation has become irregular&#44; often accompanied by bloody leucorrhea&#44; and finally&#44; secondary amenorrhea appeared&#46; No fever&#44; night sweats&#44; and weight loss&#46; Misdiagnosed as a common bacterial infection&#44; Behcet&#39;s disease&#44; or pyoderma gangrenosum in local clinics&#44; but anti-infective treatment and glucocorticoid therapy were not effective&#46; Physical examination found an ulcer with purulent exudation and infiltrative borders in the vulva &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#46; The ratio of leukocyte and neutrophil was increased&#46; Purified protein derivative skin test and tuberculin test were positive&#46; Hysteroscopy revealed bilateral adhesion of uterine horns and double fallopian tubes&#46; Fluorescent quantitative PCR detection of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> in endometrial specimens was positive&#46; Histopathology of the vulvar ulcer revealed granulomas with caseous necrosis and lymphocytic infiltrate&#44; which confirmed the diagnosis of vulvar ulcerative CTB secondary to genital TB&#46; Because the patient&#8217;s uric acid was slightly elevated&#44; pyrazinamide may cause an increase in uric acid and the patient had some gastrointestinal reactions when taking rifampicin&#44; isoniazid&#44; and ethambutol&#44; the authors did not use pyrazinamide under a comprehensive consideration&#46; The ulcer had healed by the third month and was followed up for five years without recurrence &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#46; CTB is generally a secondary infection that occurs in patients with internal organ TB&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The general clinical manifestation of ulcerative CTB is an ulcerative lesion with irregular edges and clear boundaries with a purulent base&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The presence of yellow satellite nodules around the ulcer is characteristic of ulcerative CTB&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In addition to the vulvar lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; endometrial PCR confirmed endometrial TB in our case&#46; It is a common type of genital TB&#44; which usually manifested as abnormal secretions&#44; decreased menstruation&#44; or secondary amenorrhea&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and the patient the authors reported has similar clinical manifestations above&#46; Genital TB generally affects the fallopian tubes almost 100&#37; and the vulva rarely 0&#46;07&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Here&#44; ulcerative CTB of the vulva is an external cue sign of genital TB&#46; Treatment options for various types of CTB are the same as TB&#44; and last for at least 6 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> CTB will not heal itself&#44; and it may be life-threatening if the improper or untimely treatment causes widespread transmission of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Therefore&#44; the early diagnosis and treatment of CTB are particularly important&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0010" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors&#8217; contributions</span><p id="par0015" class="elsevierStylePara elsevierViewall">Jiangfan Yu&#58; Contributed to the study concept and design&#59; wrote the manuscript&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Wenxia Huang&#58; Conducted data collection and statistical analysis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Guiying Zhang&#58; Effectively participated in the research guidance&#44; the propaedeutic and therapeutic conduct of the studied cases&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Rong Xiao&#58; Contributed to the study concept and design&#59; made a critical review of the literature and finally approved the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:6 [
        0 => array:3 [
          "identificador" => "xres1921653"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1657561"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Financial support"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Authors&#8217; contributions"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflict of interest"
        ]
        5 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-07-21"
    "fechaAceptado" => "2021-11-24"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1657561"
          "palabras" => array:4 [
            0 => "Cutaneous"
            1 => "Female genital"
            2 => "Skin ulcer"
            3 => "Tuberculosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Tuberculosis is a chronic infectious disease that gradually poses a certain threat to public health and economic growth&#46; Tuberculosis typically affects the lungs&#44; pleura&#44; and lymph nodes and rarely the skin&#46; Cutaneous tuberculosis manifesting as ulcerated lesions is also rare and often misdiagnosed and missed by clinicians&#46; Here&#44; the authors report a 29-year-old female patient presenting a vulvar ulcer for 10 months&#44; accompanied by irregular menstruation and increased vaginal secretions&#46; After a skin biopsy and endometrial PCR testing&#44; it was finally diagnosed as vulvar ulcerative cutaneous tuberculosis secondary to genital tuberculosis&#46; Anti-tuberculosis treatment was effective&#46; Cutaneous tuberculosis is called a great imitator&#46; In order to facilitate the diagnosis and treatment of tuberculosis by clinicians&#44; the authors systematically reviewed this disease as well&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology&#44; Second Xiangya Hospital&#44; Central South University&#44; China&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1649
            "Ancho" => 2508
            "Tamanyo" => 666316
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical images&#46; &#40;a&#41; The appearance of the ulcer before treatment&#46; &#40;b&#41; The ulcer healed after treatment&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1634
            "Ancho" => 2175
            "Tamanyo" => 1291683
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin &#38; eosin&#44; &#215;400&#46; A granuloma with caseous necrosis and lymphocytic infiltration&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous tuberculosis&#58; epidemiologic&#44; etiopathogenic and clinical aspects - part I"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;B&#46; Santos"
                            1 => "A&#46;R&#46; Figueiredo"
                            2 => "C&#46;E&#46; Ferraz"
                            3 => "M&#46;H&#46; Oliveira"
                            4 => "P&#46;G&#46; Silva"
                            5 => "V&#46;L&#46;S&#46; Medeiros"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20142334"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2014"
                        "volumen" => "89"
                        "paginaInicial" => "219"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24770496"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous tuberculosis presenting as lupus vulgaris"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Granado"
                            1 => "A&#46; Catarino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijid.2020.03.069"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Infect Dis&#46;"
                        "fecha" => "2020"
                        "volumen" => "96"
                        "paginaInicial" => "139"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32251800"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tuberculosis - United States&#44; 2019"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46;G&#46; Schwartz"
                            1 => "S&#46;F&#46; Price"
                            2 => "R&#46;H&#46; Pratt"
                            3 => "A&#46;J&#46; Langer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15585/mmwr.mm6911a3"
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR Morb Mortal Wkly Rep&#46;"
                        "fecha" => "2020"
                        "volumen" => "69"
                        "paginaInicial" => "286"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32191684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tuberculosis cutis orificialis in an immunocompetent patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Turkmen"
                            1 => "B&#46;G&#46; Turk"
                            2 => "G&#46; Kand&#305;loglu"
                            3 => "T&#46; Dereli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cutis&#46;"
                        "fecha" => "2015"
                        "volumen" => "95"
                        "paginaInicial" => "E4"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26125222"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Orificial tuberculosis of the lip&#58; a case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Kili&#231;"
                            1 => "U&#46; G&#252;l"
                            2 => "M&#46; G&#246;n&#252;l"
                            3 => "S&#46; Soylu"
                            4 => "S&#46;C&#46; Cakmak"
                            5 => "D&#46; Demiriz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2009.03942.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol&#46;"
                        "fecha" => "2009"
                        "volumen" => "48"
                        "paginaInicial" => "178"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19200198"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genital tuberculosis in Indian infertility patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Gupta"
                            1 => "J&#46;B&#46; Sharma"
                            2 => "S&#46; Mittal"
                            3 => "N&#46; Singh"
                            4 => "R&#46; Misra"
                            5 => "M&#46; Kukreja"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijgo.2006.12.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Gynaecol Obstet&#46;"
                        "fecha" => "2007"
                        "volumen" => "97"
                        "paginaInicial" => "135"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17362955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pathology of female genital tuberculosis&#46; A 31-year study of 1436 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Nogales-Ortiz"
                            1 => "I&#46; Taranc&#243;n"
                            2 => "F&#46;F&#46; Nogales Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "1979"
                        "volumen" => "53"
                        "paginaInicial" => "422"
                        "paginaFinal" => "428"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> complex cutaneous infection&#58; report of two cases and literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Semaan"
                            1 => "R&#46; Traboulsi"
                            2 => "S&#46; Kanj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijid.2008.03.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Infect Dis&#46;"
                        "fecha" => "2008"
                        "volumen" => "12"
                        "paginaInicial" => "472"
                        "paginaFinal" => "477"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18467143"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46;G&#46; Bravo"
                            1 => "E&#46; Gotuzzo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2006.05.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol&#46;"
                        "fecha" => "2007"
                        "volumen" => "25"
                        "paginaInicial" => "173"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17350496"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Orificial tuberculosis&#58; detection by polymerase chain reaction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Nachbar"
                            1 => "V&#46; Classen"
                            2 => "T&#46; Nachbar"
                            3 => "M&#46; Meurer"
                            4 => "C&#46;G&#46; Schirren"
                            5 => "K&#46; Degitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2133.1996.d01-943.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "1996"
                        "volumen" => "135"
                        "paginaInicial" => "106"
                        "paginaFinal" => "109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8776370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009700000006/v2_202306261757/S0365059622001817/v2_202306261757/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "80635"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Tropical&#47;Infectoparasitary Dermatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009700000006/v2_202306261757/S0365059622001817/v2_202306261757/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622001817?idApp=UINPBA00008Z"
]
Compartilhar
Informação da revista
Vol. 97. Núm. 6.
Páginas 786-788 (1 novembro 2022)
Compartilhar
Compartilhar
Baixar PDF
Mais opções do artigo
Visitas
4320
Vol. 97. Núm. 6.
Páginas 786-788 (1 novembro 2022)
Tropical/Infectoparasitary Dermatology
Acesso de texto completo
Vulvar ulcerative cutaneous tuberculosis secondary to genital tract tuberculosis
Visitas
4320
Jiangfan Yua, Wenxia Huanga,b, Guiying Zhanga, Rong Xiaoa,
Autor para correspondência
xiaorong65@csu.edu.cn

Corresponding author.
a Department of Dermatology, Second Xiangya Hospital of Central South University, Changsha, China
b Department of Dermatology, The Fifth People Hospital of Hainan Province, China
Este item recebeu
Informação do artigo
Resume
Texto Completo
Bibliografia
Baixar PDF
Estatísticas
Figuras (2)
Abstract

Tuberculosis is a chronic infectious disease that gradually poses a certain threat to public health and economic growth. Tuberculosis typically affects the lungs, pleura, and lymph nodes and rarely the skin. Cutaneous tuberculosis manifesting as ulcerated lesions is also rare and often misdiagnosed and missed by clinicians. Here, the authors report a 29-year-old female patient presenting a vulvar ulcer for 10 months, accompanied by irregular menstruation and increased vaginal secretions. After a skin biopsy and endometrial PCR testing, it was finally diagnosed as vulvar ulcerative cutaneous tuberculosis secondary to genital tuberculosis. Anti-tuberculosis treatment was effective. Cutaneous tuberculosis is called a great imitator. In order to facilitate the diagnosis and treatment of tuberculosis by clinicians, the authors systematically reviewed this disease as well.

Keywords:
Cutaneous
Female genital
Skin ulcer
Tuberculosis
Texto Completo

Tuberculosis (TB) is a public health concern caused by infection with Mycobacterium tuberculosis, typically affecting the lungs (80%) and less than 1% is cutaneous TB (CTB).1 The clinical appearance of CTB is quite varied, the most predominant form is lupus vulgaris, while ulcerative lesions are rare, constituting 2% of CTB cases.2 CTB is often misdiagnosed and missed in daily work. In this report, the authors introduce a rare case of vulvar ulcerative CTB secondary to genital TB and review the relevant literature. A 29-year-old female patient presented with a vulvar ulcer for 10 months. Since the second child was delivered by cesarean section, her menstruation has become irregular, often accompanied by bloody leucorrhea, and finally, secondary amenorrhea appeared. No fever, night sweats, and weight loss. Misdiagnosed as a common bacterial infection, Behcet's disease, or pyoderma gangrenosum in local clinics, but anti-infective treatment and glucocorticoid therapy were not effective. Physical examination found an ulcer with purulent exudation and infiltrative borders in the vulva (Fig. 1a). The ratio of leukocyte and neutrophil was increased. Purified protein derivative skin test and tuberculin test were positive. Hysteroscopy revealed bilateral adhesion of uterine horns and double fallopian tubes. Fluorescent quantitative PCR detection of Mycobacterium tuberculosis in endometrial specimens was positive. Histopathology of the vulvar ulcer revealed granulomas with caseous necrosis and lymphocytic infiltrate, which confirmed the diagnosis of vulvar ulcerative CTB secondary to genital TB. Because the patient’s uric acid was slightly elevated, pyrazinamide may cause an increase in uric acid and the patient had some gastrointestinal reactions when taking rifampicin, isoniazid, and ethambutol, the authors did not use pyrazinamide under a comprehensive consideration. The ulcer had healed by the third month and was followed up for five years without recurrence (Fig. 1b). CTB is generally a secondary infection that occurs in patients with internal organ TB.2,3 The general clinical manifestation of ulcerative CTB is an ulcerative lesion with irregular edges and clear boundaries with a purulent base.4 The presence of yellow satellite nodules around the ulcer is characteristic of ulcerative CTB.5 In addition to the vulvar lesion (Fig. 2), endometrial PCR confirmed endometrial TB in our case. It is a common type of genital TB, which usually manifested as abnormal secretions, decreased menstruation, or secondary amenorrhea,6 and the patient the authors reported has similar clinical manifestations above. Genital TB generally affects the fallopian tubes almost 100% and the vulva rarely 0.07%.7 Here, ulcerative CTB of the vulva is an external cue sign of genital TB. Treatment options for various types of CTB are the same as TB, and last for at least 6 months.8,9 CTB will not heal itself, and it may be life-threatening if the improper or untimely treatment causes widespread transmission of Mycobacterium tuberculosis.10 Therefore, the early diagnosis and treatment of CTB are particularly important.

Figure 1.

Clinical images. (a) The appearance of the ulcer before treatment. (b) The ulcer healed after treatment.

(0.64MB).
Figure 2.

Hematoxylin & eosin, ×400. A granuloma with caseous necrosis and lymphocytic infiltration.

(1.23MB).
Financial support

None declared.

Authors’ contributions

Jiangfan Yu: Contributed to the study concept and design; wrote the manuscript.

Wenxia Huang: Conducted data collection and statistical analysis.

Guiying Zhang: Effectively participated in the research guidance, the propaedeutic and therapeutic conduct of the studied cases.

Rong Xiao: Contributed to the study concept and design; made a critical review of the literature and finally approved the final version of the manuscript.

Conflict of interest

None declared.

References
[1]
J.B. Santos, A.R. Figueiredo, C.E. Ferraz, M.H. Oliveira, P.G. Silva, V.L.S. Medeiros.
Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinical aspects - part I.
An Bras Dermatol, 89 (2014), pp. 219-228
[2]
J. Granado, A. Catarino.
Cutaneous tuberculosis presenting as lupus vulgaris.
Int J Infect Dis., 96 (2020), pp. 139-140
[3]
N.G. Schwartz, S.F. Price, R.H. Pratt, A.J. Langer.
Tuberculosis - United States, 2019.
MMWR Morb Mortal Wkly Rep., 69 (2020), pp. 286-289
[4]
M. Turkmen, B.G. Turk, G. Kandıloglu, T. Dereli.
Tuberculosis cutis orificialis in an immunocompetent patient.
Cutis., 95 (2015), pp. E4-6
[5]
A. Kiliç, U. Gül, M. Gönül, S. Soylu, S.C. Cakmak, D. Demiriz.
Orificial tuberculosis of the lip: a case report and review of the literature.
Int J Dermatol., 48 (2009), pp. 178-180
[6]
N. Gupta, J.B. Sharma, S. Mittal, N. Singh, R. Misra, M. Kukreja.
Genital tuberculosis in Indian infertility patients.
Int J Gynaecol Obstet., 97 (2007), pp. 135-138
[7]
F. Nogales-Ortiz, I. Tarancón, F.F. Nogales Jr..
The pathology of female genital tuberculosis. A 31-year study of 1436 cases.
Obstet Gynecol, 53 (1979), pp. 422-428
[8]
R. Semaan, R. Traboulsi, S. Kanj.
Primary Mycobacterium tuberculosis complex cutaneous infection: report of two cases and literature review.
Int J Infect Dis., 12 (2008), pp. 472-477
[9]
F.G. Bravo, E. Gotuzzo.
Cutaneous tuberculosis.
Clin Dermatol., 25 (2007), pp. 173-180
[10]
F. Nachbar, V. Classen, T. Nachbar, M. Meurer, C.G. Schirren, K. Degitz.
Orificial tuberculosis: detection by polymerase chain reaction.
Br J Dermatol., 135 (1996), pp. 106-109

Study conducted at the Department of Dermatology, Second Xiangya Hospital, Central South University, China.

Baixar PDF
Idiomas
Anais Brasileiros de Dermatologia (Portuguese)
Opções de artigo
Ferramentas
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.