Cutaneous Lymphangiectasia Secondary To Lymph Node Tuberculosis
Riyaz Najeeba, Nair V Laxmi
Acquired cutaneous lymphangiectasia in two female patients with tuberculous lymphadenitis of the inguinal glands is described.
Cutaneous lymphangiectasia, Tuberculous lymphadenitis
Cutaneous lymphangiectasia represents a rare cutaneous condition resulting from lymphatic obstruction caused by a spectrum of scarring processes. We report 2 such cases that occurred as a consequence of lymph node tuberculosis.
A 38- year -old woman was seen with elephantiasis and multiple warty papules of the vulva of 4 years duration. The lesions occasionally ruptured and got infected. Past medical history was significant for bilateral inguinal swellings of 8 years duration. The inguinal swellings used to rupture and healed gradually with scarring in a period of 6 months. She also had irregular fever. There was no personal or family history of pulmonary tuberculosis or any history of genital ulcer.
The pubic region was oedematous and the labia majora were swollen and firm in consistency and studded with multiple papulovesicles [Figure - 1]. Inguinal region showed a few non tender, matted lymph nodes of size 2x1.5cm and scars on both sides. Systemic examination was normal.
The lymph node biopsy was consistent with tuberculous lymphadenitis and the biopsy of a cutaneous lesion showed dilated lymph spaces lined with endothelium. Other investigations were normal except for positive Mantoux text and raised ESR.
Inspite of adequate antituberculosis treatment the skin lesions persisted and hence she was sent for plastic surgical repair.
A 65-year-old woman was seen with swelling of the external genitalia of 1 year duration and multiple vulva) papules and papulovesicles of 3 months duration. She gave history of (R) inguinal swelling 5 years ago which was incised. This persisted as a discharging sinus for a long time and gradually healed with scarring. Inguinal biopsy report was tuberculous adenitis and was put on antituberculosis drugs, which she took only for 2 months. After a year she developed similar lesions on the (L) inguinal region which also suppurated and led to discharging sinuses and gradually healed. One year later she noticed elephantiasis of the vulva and gradual development of occasionally pruritic papulovesicles.
There was no history of pulmonary tuberculosis in her or in other family members. She denied any history of genital ulcer.
Skin biopsy of the warty lesion showed hyperkeratosis and acanthosis. Multiple dilated lymph spaces were seen in the upper dermis.
Majority of the cutaneous lymphangiomas are congenital in origin. Occasionally they arise from lymphatic obstruction due to malignancies,' radiation therapy,' cutaneous trauma' or secondary to infectious diseases like lymph node tuberculosis, recurrent erysipelas, filariasis and lymphogranuloma venereum. Heuvel et al described a case of vulval lymphangiectasia secondary to lymph node tuberculosis, exactly similar to our patients. Lymphangiecatses of the chest wall resulting from scarring scrofuloderma has been reported by Leonardo et al. Lymphatic obstruction leads to dilatation of lymph channels in the superficial and middermis or even in the deep dermis or subcutaneous tissues. The overlying epidermis may show varying degrees of hyperkeratosis, acanthosis and papillomatosis and may appear to enclose the ectatic lymphatic channels.
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