Clinical cases


Introduction. Lymphedema is an excessive regional interstitial accumulation of protein-rich fluids. It can be primary, mainly caused by congenital hypoplasia (Meige’s disease) or lymphatic vessel agenesis (Milroy’s disease). Infections, malignancies, chronic venous stasis, ionizing radiation, obesity, and congestive heart failure are common causes of secondary lymphedema. Although cutaneous tuberculosis may be accompanied by limgangitis, its association with chronic lymphedema is rarely mentioned in the literature.

Case report. A 70-year-old man, attended the Dermatology Clinic due to the appearance of permanent, indurated and infiltrated edema of the right lower limb, with translucent papules on the skin. The patient also presented at the level of the right calcaneal region a hyperkeratotic lesion, 1.5 cm in diameter, with an ulcerated center (the clinical appearance suggests a tuberculosis verrucosa cutis). From the medical history we highlight that, 7 years ago, after a sting in the right calcaneal region, an abscess formed at the site of the sting, which was curetted in the Surgery Department, but which recurred. After about 6 months, the right lower limb began to grow in diameter due to significant edema. For chronic lymphedema, the patient was treated with Detralex, Pentoxi Retard, Vessel Due F prior to hospitalization, with no notable results. The histopathological examination pleaded for the diagnosis of cutaneous tuberculosis. Specific treatment with tuberculostatics (Isoniazid 300 mg, Rifampicin 600 mg, Pyrazinamide 2000 mg, Ethambutol 1600 mg, 7/7) was initiated, with a duration of 9 months, the evolution being favorable with the disappearance of the verrucous lesion from the right calcaneus region, with decreased lymphedema and disappearance of papules in the right lower limb.

Discussions. Tuberculosis verrucosa cutis (TVC) is the most common form of exogenous paucibacillary tuberculosis. It is the result of primary inoculation in previously tuberculin-sensitive individuals who maintain moderate to high immunity to M. tuberculosis. It is either
self-inoculation or heteroinoculation following an accidental or professional contact. Secondary bacterial infection and chronic lymphedema are possible complications of extensive lesions that usually affect the extremities. TVC can persist for many years if not treated properly. Usually, there is a favorable response to antituberculosis therapy, as in our case.


Conclusions. Chronic lymphedema associated with tuberculosis verrucosa cutis can be cured by long-term treatment with tuberculostatics. Early diagnosis and treatment of cutaneous tuberculosis are essential to reduce complications.