CUTANEOUS TUBERCULOSIS IN A VENEZUELAN PATIENT IN THE CITY OF BOA VISTA, RORAIMA

Cutaneous tuberculosis is an extrapulmonary form caused by Mycobacterium tuberculosis or M. bovis, and may occur through exogenous inoculation or endogenous dissemination. Its manifestations include tuberculous chancre, verrucous tuberculosis, orificial tuberculosis, miliary tuberculosis, metastatic tuberculous abscess, and most cases of papulonecrotic tuberculid, varying according to the host’s level of immunity. Diagnosis and management follow systemic TB guidelines, using smear microscopy, culture for AFB, and PCR as auxiliary methods. The stage of the disease, the immunological status, and the patient’s clinical conditions guide the therapeutic choice. In immunocompromised individuals, such as those with HIV and miliary TB, early diagnosis and immediate initiation of treatment are fundamental, although the prognosis is guarded in cases of multidrug-resistant mycobacteria. For effective TB control, early detection, contact tracing, and ensuring treatment until cure are essential. This work aims to report a case of cutaneous TB in a Venezuelan patient in the State of Roraima. Case: J.H., 23 years old, previously healthy, with an up-to-date vaccination record and BCG scar, from Venezuela. In February 2024, he developed polymorphic skin lesions. A skin biopsy was performed, with no identification of microorganisms, and histopathology showed a chronic granulomatous lesion. He remained in outpatient follow-up with Dermatology and Infectious Diseases, undergoing several therapeutic regimens, including treatment for syphilis, despite negative serologies. With progression of the condition and onset of ulceration in the cervical region, a new lesion on the right leg, in addition to the pre-existing lesion in the right inguinal region, the patient was rehospitalized and had TB molecular rapid test (TRM TB) in sputum (performed in November) with traces detected, and the basic regimen was started (04 tablets PO once daily). Thigh MRI showed extensive myositis, and chest CT showed mediastinal lymphadenomegaly. Currently, the patient is undergoing outpatient treatment, shows improvement of lesions, and is responding to drug therapy. The case highlights the importance of considering cutaneous tuberculosis in the differential diagnosis of chronic skin lesions, especially in endemic regions and in migrant patients. Early diagnosis and appropriate treatment are fundamental for a favorable evolution of the case.