Prosector's wart
Encyclopedia
Tuberculosis verrucosa cutis (also known as "Lupus verrucosus," "Prosector's wart," and "Warty tuberculosis")is a rash
of small, red papular nodules in the skin
that may appear 2-4 weeks after inoculation by Mycobacterium tuberculosis
in a previously infected and immunocompetent individual.
It is so called because it was a common occupational disease
of prosector
s, the preparers of dissection
s and autopsies
. Reinfection by tuberculosis
via the skin, therefore, can result from accidental exposure to human tuberculous tissue in physician
s, pathologists and laboratory workers; or to tissues of other infected animals, in veterinarian
s, butcher
s, etc. Other names given to this form of skin tuberculosis are anatomist's wart and verruca necrogenica (literally, generated by corpses).
TVC is one of the many forms of cutaneous tuberculosis
, such as the tuberculous chancre (which results from the inoculation in people without immunity, and the reactivation cutaneous tuberculosis (the most common one, which appears in previously infected patients). Other forms of cutaneous tuberculosis are: lupus vulgaris
, scrofuloderma
, lichen scrofulosorum
, erythema induratum and the papulonecrotic tuberculid
.
It was described by René Laennec
in 1826.
, wound
or puncture in the skin (during an autopsy, for example), the most frequent site for the wart are the hand
s. But it can occur anywhere in the skin, such as in the sole of the feet, in the anus
, and, in the case of children from developing countries
, in the buttocks
and knee
s. This is because children from countries of high incidence of tuberculosis can contract the lesion after contact with tuberculous sputum
, by walking barefoot, sitting or playing on the ground.
When recent, the skin lesion has the outside appearance of a wart
or verruca, thus it can be confused with other kinds of warts. It evolves to an annular red-brown plaque with time, with central healing and gradual expansion in the periphery. In this phase, it can be confused with fungal infections such as blastomycosis
and chromoblastomycosis
.
is confirmed by a skin biopsy
and a positive culture for acid-fast bacilli. A PPD test may also result positive.
, rifampin, pyrazinamide
, and ethambutol
or streptomycin
.
Rash
A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...
of small, red papular nodules in the skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
that may appear 2-4 weeks after inoculation by Mycobacterium tuberculosis
Mycobacterium tuberculosis
Mycobacterium tuberculosis is a pathogenic bacterial species in the genus Mycobacterium and the causative agent of most cases of tuberculosis . First discovered in 1882 by Robert Koch, M...
in a previously infected and immunocompetent individual.
It is so called because it was a common occupational disease
Occupational disease
An occupational disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of occupational safety and health. An occupational disease is typically identified when it is shown that it is more prevalent in a given body of workers than in the general...
of prosector
Prosector
A prosector is a person with the special task of preparing a dissection for demonstration, usually in medical schools or hospitals. Many important anatomists began their careers as prosectors working for lecturers and demonstrators in anatomy and pathology....
s, the preparers of dissection
Dissection
Dissection is usually the process of disassembling and observing something to determine its internal structure and as an aid to discerning the functions and relationships of its components....
s and autopsies
Autopsy
An autopsy—also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present...
. Reinfection by tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
via the skin, therefore, can result from accidental exposure to human tuberculous tissue in physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s, pathologists and laboratory workers; or to tissues of other infected animals, in veterinarian
Veterinarian
A veterinary physician, colloquially called a vet, shortened from veterinarian or veterinary surgeon , is a professional who treats disease, disorder and injury in animals....
s, butcher
Butcher
A butcher is a person who may slaughter animals, dress their flesh, sell their meat or any combination of these three tasks. They may prepare standard cuts of meat, poultry, fish and shellfish for sale in retail or wholesale food establishments...
s, etc. Other names given to this form of skin tuberculosis are anatomist's wart and verruca necrogenica (literally, generated by corpses).
TVC is one of the many forms of cutaneous tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, such as the tuberculous chancre (which results from the inoculation in people without immunity, and the reactivation cutaneous tuberculosis (the most common one, which appears in previously infected patients). Other forms of cutaneous tuberculosis are: lupus vulgaris
Lupus vulgaris
Lupus vulgaris are painful cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around nose, eyelids, lips, cheeks and ears. The lesions may ultimately develop into disfiguring skin ulcers if left untreated...
, scrofuloderma
Scrofuloderma
Scrofuloderma is a skin condition caused by tuberculous involvement of the skin by direct extension, usually from underlying tuberculous lymphadenitis....
, lichen scrofulosorum
Lichen scrofulosorum
Lichen scrofulosorum is a rare tuberculid that presents as a lichenoid eruption of minute papules in children and adolescents with tuberculosis. The lesions are usually asymptomatic, closely grouped, skin-colored to reddish-brown papules, often perifollicular and are mainly found on the abdomen,...
, erythema induratum and the papulonecrotic tuberculid
Papulonecrotic tuberculid
Papulonecrotic tuberculid is usually an asymptomatic, chronic skin disorder, presenting in successive crops, skin lesions symmetrically distributed on the extensor extremities....
.
It was described by René Laennec
René Laennec
René-Théophile-Hyacinthe Laennec was a French physician. He invented the stethoscope in 1816, while working at the Hôpital Necker and pioneered its use in diagnosing various chest conditions....
in 1826.
Presentation
Because the TVC's entry point usually is the site of a traumaPhysical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, wound
Wound
A wound is a type of injury in which skin is torn, cut or punctured , or where blunt force trauma causes a contusion . In pathology, it specifically refers to a sharp injury which damages the dermis of the skin.-Open:...
or puncture in the skin (during an autopsy, for example), the most frequent site for the wart are the hand
Hand
A hand is a prehensile, multi-fingered extremity located at the end of an arm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs...
s. But it can occur anywhere in the skin, such as in the sole of the feet, in the anus
Anus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
, and, in the case of children from developing countries
Developing country
A developing country, also known as a less-developed country, is a nation with a low level of material well-being. Since no single definition of the term developing country is recognized internationally, the levels of development may vary widely within so-called developing countries...
, in the buttocks
Buttocks
The buttocks are two rounded portions of the anatomy, located on the posterior of the pelvic region of apes and humans, and many other bipeds or quadrupeds, and comprise a layer of fat superimposed on the gluteus maximus and gluteus medius muscles. Physiologically, the buttocks enable weight to...
and knee
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
s. This is because children from countries of high incidence of tuberculosis can contract the lesion after contact with tuberculous sputum
Sputum
Sputum is mucus that is coughed up from the lower airways. It is usually used for microbiological investigations of respiratory infections....
, by walking barefoot, sitting or playing on the ground.
When recent, the skin lesion has the outside appearance of a wart
Wart
A wart is generally a small, rough growth, typically on a human’s hands or feet but often other locations, that can resemble a cauliflower or a solid blister. They are caused by a viral infection, specifically by human papillomavirus 2 and 7. There are as many as 10 varieties of warts, the most...
or verruca, thus it can be confused with other kinds of warts. It evolves to an annular red-brown plaque with time, with central healing and gradual expansion in the periphery. In this phase, it can be confused with fungal infections such as blastomycosis
Blastomycosis
Blastomycosis is a fungal infection caused by the organism Blastomyces dermatitidis...
and chromoblastomycosis
Chromoblastomycosis
Chromoblastomycosis is a long-term fungal infection of the skin and subcutaneous tissue . The infection occurs most commonly in tropical or subtropical climates, often in rural areas...
.
Diagnosis
The diagnosisDiagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
is confirmed by a skin biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
and a positive culture for acid-fast bacilli. A PPD test may also result positive.
Treatment
Therapy for cutaneous tuberculosis is the same as for systemic tuberculosis, and usually consists of a 4-drug regimen, i.e., isoniazidIsoniazid
Isoniazid , also known as isonicotinylhydrazine , is an organic compound that is the first-line antituberculosis medication in prevention and treatment. It was first discovered in 1912, and later in 1951 it was found to be effective against tuberculosis by inhibiting its mycolic acid...
, rifampin, pyrazinamide
Pyrazinamide
Pyrazinamide is a drug used to treat tuberculosis. The drug is largely bacteriostatic, but can be bacteriocidal on actively replicating tuberculosis bacteria.-Abbreviations:...
, and ethambutol
Ethambutol
Ethambutol is a bacteriostatic antimycobacterial drug prescribed to treat tuberculosis. It is usually given in combination with other tuberculosis drugs, such as isoniazid, rifampicin and pyrazinamide....
or streptomycin
Streptomycin
Streptomycin is an antibiotic drug, the first of a class of drugs called aminoglycosides to be discovered, and was the first antibiotic remedy for tuberculosis. It is derived from the actinobacterium Streptomyces griseus. Streptomycin is a bactericidal antibiotic. Streptomycin cannot be given...
.
See also
- TuberculosisTuberculosisTuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
- Tuberculosis classificationTuberculosis classification-Tuberculosis classification system:The current clinical classification system for tuberculosis is based on the pathogenesis of the disease.Health care providers should comply with local laws and regulations requiring the reporting of TB. All persons with class 3 or class 5 TB should be reported...
- Tuberculosis diagnosisTuberculosis diagnosisTuberculosis is diagnosed by finding Mycobacterium tuberculosis bacteria in a clinical specimen taken from the patient. While other investigations may strongly suggest tuberculosis as the diagnosis, they cannot confirm it.-Diagnosis:...
- Tuberculosis treatmentTuberculosis treatmentTuberculosis treatment refers to the medical treatment of the infectious disease tuberculosis .The standard "short" course treatment for TB is isoniazid, rifampicin , pyrazinamide, and ethambutol for two months, then isoniazid and rifampicin alone for a further four months...
- Prosector's paronychia
External links
- Cutaneous tuberculosis. eMedicine.