Borrelial lymphocytoma cutis successfully treated with intralesional interferon-alpha-2A

Abstract

Scrofuloderma is increasingly being recognized as themost common form of cutaneous tuberculosis in adults.2,3It results from contiguous involvement of the skinoverlying tuberculosis in a deeper structure, mostcommonly a lymph node, bone, joint or epididymis.2 Bothour patients had cervical glands disease, which is the mostcommon site of involvement in scrofuloderma.4 It haspreviously been suggested that cervical gland involve-ment in tuberculosis may be related to consumption ofunpasteurized milk, leading to infection of the tonsils andsubsequently of the cervical lymph glands by Mycobacte-rium bovis.5 Our patients admitted to boiling milk beforeconsumption.The incidence of systemic tuberculosis in children withcutaneous tuberculosis has been noted to be between21.2%5 and 26%.6 The incidence of systemic involvementin adults with scrofuloderma has been found to be as highas 35%.2 There was no evidence of systemic tuberculosisin our patients. DNA polymerase chain reaction andBACTEC are the ideal techniques for the diagnosis ofcutaneous tubercular infections, but their availability andcosts are major limitations.6 We failed to find any reportin literature indicating a particular genetic predispositionto cutaneous tuberculosis. But the occurrence of a specificform of cutaneous tuberculosis in these siblings mayindicate activity of a common genetically mediatedimmunological pathway.