(Lichen scrofulosorum) (202-Behl lCfh, 1756-Dorland 28th, 219- Neena khanna)TUBERCULIDES - Group of disease where the evidence for a tuberculous etiology is not definite {May be hypersensitivity reaction) but which show a tuberculous granuloma on histology and respond to ATT)Conditions included in TuberculidsCutaneous Tuberculosis (Non Tuberculides)* Lichen scrofulosorum* Lupus vulgaris* Erythema- induratum* Sacrofuloderma* Papulonecrotc tuberculides (Acne-scrafulosorum)* Tubercularis cutis verrucosus* Lupus miliaris disseminatus faciei* Miliary tuberculosis and metastatic tuberculosis* Rosaceous tuberculide* Miliary tuberculosis and metastatic tuberculosis abscess may also present as cutaneous tuberculosis(According to 'Behl' Erythema - nodosum is also a tuberculide while some texts do not include it as a tuberculide)Features of TB in AIDS patients* |Sputum positivity *** Little or no cavitation*** |ed extra pulmonary tuberculosis *** Negative PPD skin test*** Lack of classic granuloma* Atypical CXR- Diffuse interstitial or military infiltrate* Response to short course chemotherapy is similar*** but adverse effects may be more pronounced including severe or even fatal skin disease* High rate of reactivation Indications of pulmonary resection in tuberculosis / haemoptysis areAbsoluteRelative* Massive haemoptysis (600cc/24 hours)* Destroyed lung, positive sputum* Bronchopleural fistula* Suspicion of carcinoma* Haemoptysis* Bronchial stenosis* Persistent positive sputum* Open negative cavity* T.B. Empyema* Atypical tuberculus infections* Aspergilloma (Fungus balls)Lupus - vulgaris - is a form of cutaneous tuberculosis that is seen in previously infected and sensitized individualsLupus- pernio - is a particular type of sarcoidosis that involves the tip of nose & earlobes with lesions that are violaceous in colourSpino- ventosa - Tuberculosis of bone in which bone is expanded & the cortex thins eg digitsScrofuloderma - Tuberculosis first develops in a lymph node or a bone producing a swelling and subsequently ruptures through the overlying skinFalse negative tuberculin skin test - reactions may result from improper testing technique - concurrent infections, malnutrition advanced age, immunologic disorders, lymphoreticular malignancies, corticosteroid therapy, CRF, HIV infections and fulminant tuberculosis