CUTANEOUS TUBERCULOSIS WITH A SPOROTRICHOSIS-LIKE PATTERN IN BRAZIL: UNUSUAL PRESENTATION OF A COMMON DISEASE

Cutaneous Tuberculosis (CT), a rare and difficult-to-diagnose form, represents less than 2% of extrapulmonary cases and has varied clinical manifestations. The sporotrichosis-like form, with nodules along the lymphatic pathway, mimics other dermatoses. Therefore, we report a case with this presentation associated with a lupus vulgaris-like lesion, in addition to a review of similar cases in the literature. A scoping review was carried out in MEDLINE, LILACS, and EMBASE. After exclusion of duplicates and ineligible articles, 22 articles were included, totaling 27 cases of sporotrichosis-like CT. Additionally, we present the report of a patient seen at a reference hospital in Brazil. Male, 34 years old, immunocompetent, with ulcerated lesions on the distal phalanges and ipsilateral linear nodules on the left arm, beginning 6 months earlier, as well as an infiltrated plaque on the scapula, productive cough, daily fever, and weight loss for at least one year. CT scans showed cavitary pulmonary lesions, spondylodiscitis, and rib osteomyelitis. Diagnosis was confirmed by molecular test, geneXpert, and positive culture for Mycobacterium tuberculosis in bronchoalveolar lavage samples and skin biopsies. The patient evolved with resolution of lesions after treatment with the standard regimen for 18 months. In the scoping review, there was predominance of cases reported in India. Most patients did not have immunosuppression and lesions generally started on the extremities, associated or not with trauma, with duration ranging from weeks to years. A large portion of authors suggested external inoculation as the form of disease involvement. In addition, biopsies revealed tuberculoid granulomas in 74% of cases, but with low sensitivity of Ziehl-Neelsen staining and culture positivity of 44%. GeneXpert was used in only 3 of the 27 cases. CT can occur by direct inoculation from an exogenous source, by endogenous dissemination, or by contiguity and by hematogenous dissemination. In the described patient, involvement of multiple systems suggests hematogenous dissemination; however, it is not possible to rule out that the lesion on the back and on the fingers occurred from an exogenous source, different from most cases found in the literature. Therefore, recognition of these atypical presentations and use of molecular tests are fundamental to enable diagnosis, treatment, and disease control.