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Correspondence to Professor Sunita Aggarwal; [email protected]
Background
Tuberculosis (TB) is one of the most prevalent communicable infectious diseases. TB is known to affect different body tissues with variable clinical manifestations, and among them TB-related vasculitis is one of the rare presentations. Vasculitis can affect blood vessels of all sizes, resulting in multisystemic involvement with a variety of signs and symptoms. It can be classified into large vessel, medium vessel and small vessel vasculitis, depending on the type of vessel affected. Cutaneous leucocytoclastic vasculitis (CLV) is a small vessel vasculitis that majorly involves dermal postcapillary venules.1 It can be idiopathic or secondary to systemic vasculitis disorders, autoimmune diseases, neoplasm, drug hypersensitivity and infections. Among infectious causes, TB is a rare one. Here, we present the case of a woman, who initially presented with CLV, and after extensive workup, was found to be having disseminated TB as an underlying aetiology. This case demonstrates this rare association between TB and CLV.
Case presentation
A woman in her early 20s presented with complaints of fever for 20 days. It was insidious in onset and of low grade. It was associated with fatigue, malaise, anorexia and relieved on taking paracetamol. Eight days later, she developed discrete erythematous maculopapular eruptions of size varying from 0.1×0.1 cm to 1×1 cm over bilateral legs and feet. Eruptions were painless, non-blanchable and non-pruritic. She was having a dry cough for 10 days. She did not have any other localising symptoms or chronic illness. She had regular menstrual cycles. She was not taking any other drugs. No history of any kind of substance abuse and contact with pulmonary TB case. She was vaccinated with BCG at birth. On examination, she had pallor, mild bilateral pitting type pedal oedema. Rest of the systemic examination was unremarkable.
Investigations
She underwent multiple investigations to identify the underlying disease. She had microcytic hypochromic anaemia with haemoglobin 64g/L and reticulocyte production index of 0.5. Total leucocyte and platelet count were normal. She had hypoproteinaemia with serum protein 4.7 g/dL and serum albumin 2.2 g/dL. Rest of her liver and kidney function tests was normal. The erythrocyte sedimentation rate (78 mm/hour) was raised. Her ferritin level (243 mcg/L) was raised, serum iron level (42 mcg/dL) was low, vitamin B12 and...