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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M&#46; tuberculosis</span> infection remains a highly relevant topic worldwide and it is estimated that approximately 25&#37; of the population is infected&#44; with 95&#37; of cases occurring in developing countries<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall">The manifestations of tuberculosis can be divided into pulmonary and extrapulmonary&#44; the latter occurring in approximately 15&#37; of cases<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a>&#46; Skin involvement in tuberculosis is rare&#44; and represents less than 2&#37; of extrapulmonary manifestations<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">The main agent responsible for the skin lesions is <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>&#44; but they can also be caused by <span class="elsevierStyleItalic">M&#46; bovis</span> or the BCG vaccine<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a>&#46; They can manifest as inflammatory papules&#44; verrucous plaques&#44; chronic ulcers or suppurative nodes&#44; as in the case presented<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#46; This variety results from the mechanism of entry of <span class="elsevierStyleItalic">M&#46; tuberculosis</span> into the skin &#40;autoinoculation&#44; exogenous inoculation or hematogenous route&#41; <a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>&#44; the patient&#39;s immune status&#44; sensitization of the host to the agent <a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#44; factors inherent to the host such as age&#44; sex and race&#44; and environmental factors such as climate and geographic location <a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">Skin lesions are essentially divided into <span class="elsevierStyleItalic">true cutaneous TB</span>&#44; a direct result of infection&#44; and <span class="elsevierStyleItalic">tuberculids</span>&#44; indicating hypersensitivity to <span class="elsevierStyleItalic">M&#46; tuberculosis</span> antigens<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#46; Sarcoidosis&#44; abscesses&#44; and nontuberculous infections are common differential diagnoses<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#46; The diagnosis can be challenging&#44; culture and histological study must be performed&#44; histopathology can show nonspecific inflammation&#44; without the formation of granulomas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>&#46; The definitive diagnosis is confirmed by a positive culture for <span class="elsevierStyleItalic">M&#46; tuberculosis</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="para0006" class="elsevierStylePara elsevierViewall">The authors present the case report of a 75-year-old independent man who visited his Assistant Physician due to a 6-month history&#44; approximately&#44; of multiple&#44; recurrent&#44; suppurating skin lesions in the right and left supraclavicular regions and upper thoracic regions&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">On physical examination&#44; the lesions had painless&#44; granulomatous ulcer with a fibrinous base and the patient had another abscess next to the sternocleidomastoid muscle&#46; He also showed signs of collateral circulation &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0008" class="elsevierStylePara elsevierViewall">This was immunocompetent patient with no relevant medical history and no usual chronic medication&#46; Laboratory results showed a slight increase in inflammatory markers &#40;PCR 5&#46;81&#8239;mg&#47;dl&#41; with negative procalcitonin and serum tumor markers&#46; Computed tomography of the neck and chest showed several abscesses&#44; namely in the right and posterior lateral cervical region and in the right supraclavicular cavity &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#41;&#44; there was no pulmonary involvement&#46; The patient underwent a video bronchial fibroscopy that showed no endobronchial lesions&#59; the microbiology and cytology of the aspirate and bronchoalveolar lavage were negative&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0009" class="elsevierStylePara elsevierViewall">The abscess in the right supraclavicular cavity was aspirated&#46; The cytology revealed a necrotic area with an associated inflammatory process and the culture in Loewenstein-Zensen medium was positive for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>&#46; The patient was sent to the Pneumology Diagnosis Center &#40;CDP&#41; and began treatment with the four initial antitubercular drugs &#40;isoniazid 300&#8239;mg&#47;day&#44; rifampin 600&#8239;mg&#47;day&#44; pyrazinamide 1500&#8239;mg&#47;day and ethambutol 1200&#8239;mg&#47;day&#41;&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">The treatment is similar to that of systemic tuberculosis&#44; with tuberculostatic drugs<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#44; and biopsies or surgical debridement may sometimes be necessary<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>&#46; With the exception of disseminated miliary cutaneous forms&#44; skin lesions respond well to treatment and have a good prognosis <a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">With this case&#44; the authors intend to show a rare form of a condition that still has a very negative impact on World Public Health&#44; reinforcing the need to maintain strong clinical suspicion <a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> so as not to delay the start of effective therapy&#46;</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Funding</span><p id="para0012" class="elsevierStylePara elsevierViewall">The authors declare that no funding was received for this paper&#46;</p></span></span>"
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Show me your skin and I will tell you who you are
Catarina Cascais-Costaa,
Corresponding author
catarinacascaisc@gmail.com

Corresponding author.
, Catarina S. Carvalhob, Carla Valentea, Gilberto Teixeiraa
a Pulmonology Department, Centro Hospitalar Baixo Vouga – Hospital Infante D. Pedro, Aveiro, Portugal
b Intensive Medicine Department, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, Portugal
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a direct result of infection&#44; and <span class="elsevierStyleItalic">tuberculids</span>&#44; indicating hypersensitivity to <span class="elsevierStyleItalic">M&#46; tuberculosis</span> antigens<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#46; Sarcoidosis&#44; abscesses&#44; and nontuberculous infections are common differential diagnoses<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#46; The diagnosis can be challenging&#44; culture and histological study must be performed&#44; histopathology can show nonspecific inflammation&#44; without the formation of granulomas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>&#46; The definitive diagnosis is confirmed by a positive culture for <span class="elsevierStyleItalic">M&#46; tuberculosis</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="para0006" class="elsevierStylePara elsevierViewall">The authors present the case report of a 75-year-old independent man who visited his Assistant Physician due to a 6-month history&#44; approximately&#44; of multiple&#44; recurrent&#44; suppurating skin lesions in the right and left supraclavicular regions and upper thoracic regions&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">On physical examination&#44; the lesions had painless&#44; granulomatous ulcer with a fibrinous base and the patient had another abscess next to the sternocleidomastoid muscle&#46; He also showed signs of collateral circulation &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0008" class="elsevierStylePara elsevierViewall">This was immunocompetent patient with no relevant medical history and no usual chronic medication&#46; Laboratory results showed a slight increase in inflammatory markers &#40;PCR 5&#46;81&#8239;mg&#47;dl&#41; with negative procalcitonin and serum tumor markers&#46; Computed tomography of the neck and chest showed several abscesses&#44; namely in the right and posterior lateral cervical region and in the right supraclavicular cavity &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#41;&#44; there was no pulmonary involvement&#46; The patient underwent a video bronchial fibroscopy that showed no endobronchial lesions&#59; the microbiology and cytology of the aspirate and bronchoalveolar lavage were negative&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0009" class="elsevierStylePara elsevierViewall">The abscess in the right supraclavicular cavity was aspirated&#46; The cytology revealed a necrotic area with an associated inflammatory process and the culture in Loewenstein-Zensen medium was positive for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>&#46; The patient was sent to the Pneumology Diagnosis Center &#40;CDP&#41; and began treatment with the four initial antitubercular drugs &#40;isoniazid 300&#8239;mg&#47;day&#44; rifampin 600&#8239;mg&#47;day&#44; pyrazinamide 1500&#8239;mg&#47;day and ethambutol 1200&#8239;mg&#47;day&#41;&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">The treatment is similar to that of systemic tuberculosis&#44; with tuberculostatic drugs<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>&#44; and biopsies or surgical debridement may sometimes be necessary<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>&#46; With the exception of disseminated miliary cutaneous forms&#44; skin lesions respond well to treatment and have a good prognosis <a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">With this case&#44; the authors intend to show a rare form of a condition that still has a very negative impact on World Public Health&#44; reinforcing the need to maintain strong clinical suspicion <a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> so as not to delay the start of effective therapy&#46;</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Funding</span><p id="para0012" class="elsevierStylePara elsevierViewall">The authors declare that no funding was received for this paper&#46;</p></span></span>"
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Article information
ISSN: 25310437
Original language: English
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