Superficial thrombophlebitic tuberculide.

BACKGROUND: Tuberculides are the result of immunologic reactions to hematogenously spread antigenic components of Mycobacterium tuberculosis. There are three recognized tuberculides--papulonecrotic tuberculide, erythema induratum of Bazin, and lichen scrofulosorum. In 1997, in Japan, Hara and coworkers reported five patients with what they called "nodular granulomatous phlebitis," which they proposed was a fourth type of tuberculide. We describe a patient who presented with features identical to those reported by Hara et al. in order to draw attention to the previous report and to support the concept of a fourth tuberculide which clinically resembles superficial thrombophlebitis.

METHODS: A black South African man presented with cord-like thickening of superficial veins on the antero-medial aspects of the lower legs. Nodular swellings were palpable along the course of these veins. There was no evidence of tuberculosis elsewhere in the body, but the patient had a strongly positive tuberculin reaction. Skin biopsies were performed for histologic examination, culture, and polymerase chain reaction (PCR).

RESULTS: Histologic examination showed a granulomatous infiltrate localized to the veins in the subcutaneous fat. Stains for acid-fast bacilli and culture were negative, but PCR was positive for M. tuberculosis DNA. The lesions responded promptly to antituberculous therapy.

CONCLUSIONS: Our patient showed features identical to those of cases described by Hara and coworkers and assigned as a fourth type of tuberculide. As the lesions clinically resemble superficial thrombophlebitis, we propose the term "superficial thrombophlebitic tuberculide" rather than "nodular granulomatous phlebitis."