Cutaneous miliary tuberculosis in the AIDS era: case report and review

Abstract

Tuberculosis with extrapulmonary manifestations is common in patients with AIDS. The skin is a site of dissemination that has often been overlooked. Historically, cutaneous miliary tuberculosis, also known as tuberculosis cutis miliaris disseminata, was noted to be a rare entity in adults; however, over the past 5 years, five cases of cutaneous miliary tuberculosis in human immunodeficiency virus (HIV)-seropositive individuals have been reported. We present the sixth such case and review the medical literature on cutaneous miliary tuberculosis in adults both before and during the AIDS era. The incidence of tuberculosis cutis miliaris disseminata in HIV-seropositive adults is likely higher than the incidence among the HIV-seronegative population that has been suggested in the historical literature. Its appearance can be quite nondescript; a high index of suspicion must be maintained, particularly for those patients with a CD4 cell count of < 200/mm3, to achieve the proper diagnosis and initiate appropriate therapy.