Journal Article

Disseminated Miliary Tuberculosis of the Skin in Patients with AIDS: Report of Four Cases

G. L. Daikos, R. B. Uttamchandani, C. Tuda, M. A. Fischl, N. Miller, T. Cleary and M. J. Saldana

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 27, issue 1, pages 205-208
Published in print July 1998 | ISSN: 1058-4838
Published online July 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514608
Disseminated Miliary Tuberculosis of the Skin in Patients with AIDS: Report of Four Cases

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We present clinical, bacteriologic, and pathological findings for four patients with AIDS and cutaneous miliary tuberculosis. All patients had generalized tuberculosis with hematogenous dissemination to multiple organs including the skin. Microscopic examination of the skin lesions revealed ill-formed or no granulomata, extensive necrosis, and numerous acid-fast bacilli. Mycobacterium tuberculosis was detected in the skin lesions by cultures for three patients and by polymerase chain reaction for one. Three of the isolates were resistant to at least isoniazid and rifampin, and one was susceptible to these drugs. The outcome was rapidly fatal for the three patients with multidrug-resistant tuberculosis. This report draws attention to the reappearance of a once-rare manifestation of disseminated tuberculosis which, in the setting of advanced human immunodeficiency virus disease, may offer the first indication of infection with multidrug-resistant M. tuberculosis and a poor prognosis.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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