TITLE:
Disseminated Tuberculosis Presenting with Scrofuloderma and Anterior Staphyloma in a Child in Sokoto, Nigeria
AUTHORS:
Khadijat O. Isezuo, Ridwan M. Jega, Bilkisu I. Garba, Usman M. Sani, Usman M. Waziri, Olubusola B. Okwuolise, Hassan M. Danzaki
KEYWORDS:
Scrofuloderma, Staphyloma, Corneal Ulcer, Disseminated TB, Sokoto
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.8 No.3,
August
6,
2020
ABSTRACT: Introduction: Disseminated tuberculosis (TB) may occur with skin and ocular
involvement which are not common manifestations in children and may lead to
debilitating complications. Objective: A child with multi-organ TB
involving the lungs, chest abdomen, skin and eyes who had been symptomatic for
3 years is reported. Case Report: A 6-year-old
girl presented with recurrent fever, abdominal pain and weight loss of 3 years
and skin lesions of a year duration. There was history of pain and redness of
the eyes associated with discharge. She was not vaccinated at all. She was
chronically ill-looking with bilateral conjunctival hyperaemia, purulent eye
discharge with corneal opacity of the right eye. She had significant
lymphadenopathy, digital clubbing and ulcerated, discharging swellings around
her neck and axilla (scrofuloderma). She had reduced breath sounds and coarse
crepitations. Hepatosplenomegaly and ascites were present. She later developed
bulging of the upper part of the cornea of the right eye which was diagnosed by
the ophthalmologist to be cornea ulcer with anterior staphyloma. Results,
Treatment and Outcome: Complete blood count (leucocytosis 12,800 cells),
erythrocyte sedimentation rate (150 mm/hr) and tuberculin test (7 mm
induration) were suggestive of TB. Radiological tests were also supportive. She
received anti-Kochs in addition to systemic and ocular antibiotics. Skin
lesions healed progressively and stopped discharging. Caregivers were counseled
on poor visual prognosis of the right eye. She was discharged but lost to
follow up. Conclusion: Multi-organ involvement of TB especially ocular
and cutaneous TB is not common but is very debilitating. More preventive efforts with vaccination and
expertise are needed at lower levels of health care in the community to aid early
diagnosis.