{"id":22069,"date":"2021-04-24T16:58:07","date_gmt":"2021-04-24T13:58:07","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=22069"},"modified":"2021-06-02T17:19:58","modified_gmt":"2021-06-02T14:19:58","slug":"tuberkulozun-nadir-gorulen-bir-formu-kutanoz-tuberkuloz-olgulari","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/04\/24\/tuberkulozun-nadir-gorulen-bir-formu-kutanoz-tuberkuloz-olgulari\/","title":{"rendered":"T\u00fcberk\u00fclozun Nadir G\u00f6r\u00fclen Bir Formu: Kutan\u00f6z T\u00fcberk\u00fcloz Olgular\u0131"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/strong><\/h2>\n

T\u00fcberk\u00fcloz, Mycobacterium tuberculosis<\/em>\u2019in neden oldu\u011fu t\u00fcm organ ve dokular\u0131 tutabilen bir infeksiyon hastal\u0131\u011f\u0131d\u0131r. Ekstrapulmoner t\u00fcberk\u00fcloz, primer infeksiyon s\u0131ras\u0131nda lenfohematojen yolla di\u011fer organlara yay\u0131lan ve latent kalan t\u00fcberk\u00fcloz basilinin hayat\u0131n herhangi bir d\u00f6neminde reaktive olmas\u0131yla geli\u015fmektedir. T\u00fcberk\u00fcloz lenfadenit ve plevra t\u00fcberk\u00fclozu ekstrapulmoner t\u00fcberk\u00fclozun en s\u0131k g\u00f6r\u00fclen formlar\u0131d\u0131r (1-3). Deri t\u00fcberk\u00fclozlar\u0131 ise %1-1.5 g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131yla ekstrapulmoner t\u00fcberk\u00fclozlar\u0131n \u00e7ok az bir k\u0131sm\u0131n\u0131 olu\u015fturmaktad\u0131r. Deri t\u00fcberk\u00fclozunda etken; M. tuberculosis, M. bovis<\/em> nadir olarak da M. bovis<\/em>\u2019in attenue su\u015fu Bacillus Calmette\u2013Gu\u00e9rin (BCG)\u2019dir (4).<\/p>\n

Primer deri t\u00fcberk\u00fclozlar\u0131; t\u00fcberk\u00fcloz primer kompleks (t\u00fcberk\u00fcloz \u015fankr\u0131) ve \u201ctuberculosis cutis miliaris\u201d (miliyer deri t\u00fcberk\u00fclozu)\u2019tir. Sekonder cilt t\u00fcberk\u00fclozlar\u0131 ise; lupus vulgaris, \u201ctuberculosis verrucosa cutis\u201d, skrofuloderma, \u201ctuberculosis cutis orificialis\u201d ve metastatik t\u00fcberk\u00fcloz apseleridir. En s\u0131k g\u00f6r\u00fclen formu lupus vulgaristir. Deri t\u00fcberk\u00fclozu olgular\u0131nda klinik belirtilerin geni\u015f bir spektruma sahip olmas\u0131 nedeniyle tan\u0131 ve tedavide gecikmeler olabilmektedir (1,4).<\/p>\n

Bu yaz\u0131da son bir y\u0131l i\u00e7erisinde klini\u011fimize ba\u015fvuran, bir\u00e7ok sa\u011fl\u0131k kurulu\u015funda tan\u0131 konulamayan deri t\u00fcberk\u00fclozu olgular\u0131 incelenmi\u015ftir.<\/p>\n

OLGU 1<\/strong><\/h2>\n
\"\"<\/a>

Resim 1. <\/strong>Olgu lezyonlar\u0131n\u0131n tedavi \u00f6ncesi ve sonras\u0131 g\u00f6r\u00fcnt\u00fcleri.<\/p><\/div>\n

Yetmi\u015f dokuz ya\u015f\u0131nda kad\u0131n hasta poliklini\u011fimize sol kolda \u015fi\u015flik, d\u00f6k\u00fcnt\u00fc ve sol kulak kep\u00e7esinde yara \u015fikayetiyle ba\u015fvurdu. \u00d6yk\u00fcs\u00fcnden bu \u015fikayetle yakla\u015f\u0131k 1.5 y\u0131ld\u0131r bir \u00e7ok sa\u011fl\u0131k kurulu\u015funa ba\u015fvurdu\u011fu ve de\u011fi\u015fik tedaviler ald\u0131\u011f\u0131 ancak \u015fikayetlerinin gerilemedi\u011fi \u00f6\u011frenildi. Yirmi d\u00f6rt y\u0131l \u00f6nce akci\u011fer t\u00fcberk\u00fclozu ge\u00e7iren hastan\u0131n fizik muayenesinde sol kolunda \u015fi\u015flik, hiperpigmente alanlar ve mak\u00fclopap\u00fcler d\u00f6k\u00fcnt\u00fcs\u00fc oldu\u011fu, ayr\u0131ca sol kulak kep\u00e7esinde de benzer lezyonlar bulundu\u011fu tespit edildi (Resim 1A ve 1B). Di\u011fer sistem muayeneleri normal olarak de\u011ferlendirildi. Tetkiklerinde l\u00f6kosit say\u0131s\u0131 5400 h\u00fccre\/mm3<\/sup> (4000-10 000 h\u00fccre\/mm3<\/sup>), hemoglobin 12.4 gr\/dl (12-16 gr\/dl), platelet say\u0131s\u0131 285 000 h\u00fccre\/mm3<\/sup> (150 000-450 000 h\u00fccre\/mm3<\/sup>), eritrosit sedimantasyon h\u0131z\u0131 (ESR) 76 mm\/1.saat, C-reaktif protein (CRP) 2.8 mg\/dl (0-0.8 mg\/dl) olarak saptand\u0131. PPD 20 mm ve interferon \u03b3-sal\u0131n\u0131m (IGS) testi pozitif olan hasta Dermatoloji Klini\u011fi\u2019yle kons\u00fclte edildi. Dermatoloji Klini\u011fi taraf\u0131ndan hastan\u0131n lezyonlar\u0131n\u0131n \u201ctuberculosis verrucosa cutis\u201d veya lupus vulgaris olabilece\u011fi d\u00fc\u015f\u00fcn\u00fcld\u00fc. Hastan\u0131n kolundaki ve kula\u011f\u0131ndaki lezyonlardan biyopsi al\u0131nd\u0131. Al\u0131nan \u00f6rneklerde asidorezistan basil (ARB) g\u00f6r\u00fclmedi ve t\u00fcberk\u00fcloz PCR negatif olarak tespit edildi. Ancak hastan\u0131n patoloji sonucunun gran\u00fclomat\u00f6z infeksiyonla uyumlu saptanmas\u0131, ge\u00e7mi\u015finde t\u00fcberk\u00fcloz ge\u00e7irme \u00f6yk\u00fcs\u00fcn\u00fcn bulunmas\u0131, lezyonlar\u0131n\u0131n g\u00f6r\u00fcn\u00fcm\u00fcn\u00fcn t\u00fcberk\u00fclozla uyumlu olmas\u0131 ayr\u0131ca PPD ve IGS testlerinin de pozitif saptanmas\u0131 \u00fczerine hastaya d\u00f6rtl\u00fc antit\u00fcberk\u00fcloz (izoniyazid [INH] 300 mg, rifampisin [RIF] 600 mg, etambutol [ETM] 1500 mg, pirazinamid [PZA] 2000 mg) tedavi ba\u015fland\u0131. Tedavi ba\u015fland\u0131ktan sonra sonu\u00e7lanan t\u00fcberk\u00fcloz k\u00fclt\u00fcr\u00fcnde M. tuberculosis<\/em> complex \u00fcredi ve ila\u00e7 direnci saptanmad\u0131. Tedaviyle hastan\u0131n lezyonlar\u0131 gerilemeye ba\u015flad\u0131. Tedavinin d\u00f6rd\u00fcnc\u00fc ay\u0131ndan sonra lezyonlar\u0131 tamamen d\u00fczeldi. Hastan\u0131n tedavisi 6 aya tamamlanarak kesildi (Resim 1C ve 1D).<\/p>\n

OLGU 2<\/strong><\/h2>\n
\"\"<\/a>

Resim 2.<\/strong> Lezyonlar\u0131n tedavi \u00f6ncesi ve sonras\u0131 g\u00f6r\u00fcnt\u00fcleri.<\/p><\/div>\n

Yirmi ya\u015f\u0131nda kad\u0131n hasta poliklini\u011fimize sol dirsekte yara \u015fikayetiyle ba\u015fvurdu. \u00d6yk\u00fcs\u00fcnden 6 ay \u00f6nce dirsekte \u015fi\u015flik, k\u0131zar\u0131kl\u0131k, a\u011fr\u0131 \u015fikayetinin ba\u015flad\u0131\u011f\u0131, bir hafta sonra ayn\u0131 yerde yara olu\u015ftu\u011fu bu \u015fikayetlerle bir\u00e7ok sa\u011fl\u0131k kurulu\u015funa ba\u015fvurdu\u011fu, de\u011fi\u015fik tetkikler yap\u0131l\u0131p tedaviler verildi\u011fi ancak \u015fikayetlerinde d\u00fczelme olmad\u0131\u011f\u0131 \u00f6\u011frenildi. Ayr\u0131ca hasta ayn\u0131 evde ya\u015fad\u0131\u011f\u0131 babaannesinde de benzer bir yaran\u0131n \u00e7\u0131kt\u0131\u011f\u0131n\u0131, deri t\u00fcberk\u00fclozu tan\u0131s\u0131 ald\u0131\u011f\u0131n\u0131 ve tedaviyle d\u00fczeldi\u011fini ifade etti. Fizik muayenesinde sol dirsekte merkezi kurutlu, etraf\u0131 k\u0131zar\u0131k, b\u00fcy\u00fc\u011f\u00fc 3\u00d73 cm, k\u00fc\u00e7\u00fc\u011f\u00fc 1\u00d71 cm olmak \u00fczere iki yara tespit edildi (Resim 2A). Tetkiklerinde l\u00f6kosit say\u0131s\u0131 5100 h\u00fccre\/mm3<\/sup> (4000-10 000 h\u00fccre\/mm3<\/sup>), hemoglobin 12.6 gr\/dl (12-16 gr\/dl), platelet say\u0131s\u0131 198 000 h\u00fccre\/mm3<\/sup> (150 000-450 000 h\u00fccre\/mm3<\/sup>), ESR 38 mm\/1.saat, CRP 0.2 mg\/dl (0-0.8 mg\/dl) tespit edildi. PPD 22 mm ve IGS testi pozitif olan hasta Dermatoloji Klini\u011fi\u2019yle kons\u00fclte edildi. Dermatoloji Klini\u011fi taraf\u0131ndan hastan\u0131n lezyonlar\u0131n\u0131n lupus vulgaris olabilece\u011fi d\u00fc\u015f\u00fcn\u00fcld\u00fc ve biyopsi al\u0131nd\u0131. Al\u0131nan \u00f6rnekte ARB g\u00f6r\u00fclmedi ve mikobakteri k\u00fclt\u00fcr\u00fcnde \u00fcreme olmad\u0131. Patoloji sonucu gran\u00fclomat\u00f6z infeksiyonla uyumlu gelen hasta tularemi, mantar infeksiyonlar\u0131 ve bakteriyel infeksiyonlar a\u00e7\u0131s\u0131ndan tarand\u0131. Tularemi testi negatif olarak saptanan hastan\u0131n k\u00fclt\u00fcrlerinde \u00fcreme olmad\u0131. Hastaya ay\u0131r\u0131c\u0131 tan\u0131da de\u011ferlendirilen infeksiyonlar\u0131n olmamas\u0131, t\u00fcberk\u00fcloz a\u00e7\u0131s\u0131ndan aile \u00f6yk\u00fcs\u00fcn\u00fcn olmas\u0131, lezyonlar\u0131n\u0131n g\u00f6r\u00fcn\u00fcm\u00fcn\u00fcn t\u00fcberk\u00fclozla uyumlu olmas\u0131 ayr\u0131ca PPD ve IGS testlerinin pozitif saptanmas\u0131 \u00fczerine d\u00f6rtl\u00fc antit\u00fcberk\u00fcloz (INH 300 mg, RIF 600 mg, ETM 1500 mg, PZA 2000 mg) tedavisi ba\u015fland\u0131. Tedaviyle hastan\u0131n lezyonlar\u0131 gerilemeye ba\u015flad\u0131. Tedavinin \u00fc\u00e7\u00fcnc\u00fc ay\u0131ndan sonra lezyonlar\u0131 tamamen d\u00fczeldi. Tedavisi alt\u0131 aya tamamlanarak kesildi (Resim 2B).<\/p>\n

OLGU 3<\/strong><\/h2>\n
\"\"<\/a>

Resim 3.<\/strong> Lezyonlar\u0131n tedavi \u00f6ncesi ve sonras\u0131 g\u00f6r\u00fcnt\u00fcleri.<\/p><\/div>\n

Yirmi sekiz ya\u015f\u0131nda erkek hasta sol el ikinci parma\u011f\u0131nda yara \u015fikayetiyle poliklini\u011fimize ba\u015fvurdu. Hastan\u0131n yakla\u015f\u0131k 2 y\u0131l \u00f6nce parma\u011f\u0131nda \u015fi\u015flik, k\u0131zar\u0131kl\u0131k ve a\u011fr\u0131 \u015fikayetinin ba\u015flad\u0131\u011f\u0131, daha sonra k\u0131rm\u0131z\u0131 kabuklu bir yara \u00e7\u0131kt\u0131\u011f\u0131 \u00f6\u011frenildi. Bu \u015fikayetle bir\u00e7ok sa\u011fl\u0131k kurulu\u015funa ba\u015fvuran hasta \u00e7ok farkl\u0131 tedaviler ald\u0131\u011f\u0131n\u0131, ancak \u015fikayetlerinin ge\u00e7medi\u011fini ifade etti. Fizik muayenesinde sol el ikinci parma\u011f\u0131nda 1\u00d71 cm ebad\u0131nda \u00e7evresi k\u0131zar\u0131k ortas\u0131 kurutlu bir hiperkerotik lezyon mevcuttu. di\u011fer sistem muayeneleri normal olarak de\u011ferlendirildi (Resim 3A). Tetkiklerinde l\u00f6kosit say\u0131s\u0131 9200 h\u00fccre\/mm3<\/sup> (4000-10 000 h\u00fccre\/mm3<\/sup>), hemoglobin 16.4 gr\/dl (12-16 gr\/dl), platelet say\u0131s\u0131 288 000 h\u00fccre\/mm3<\/sup> (150 000-450 000 h\u00fccre\/mm3<\/sup>), ESR 2 mm\/1.saat, CRP 0.2 mg\/dl (0-0.8 mg\/dl) idi. PPD 20 mm ve IGS testi pozitif saptand\u0131. Dermatoloji Klini\u011finde \u201ctuberculosis verrucosa cutis\u201d \u00f6n tan\u0131s\u0131yla biyopsi al\u0131nd\u0131. Biyopsi sonucu gran\u00fclomat\u00f6z infeksiyonla uyumlu olup kazeifikasyon nekrozu saptand\u0131. Hastan\u0131n lezyonlar\u0131ndan al\u0131nan \u00f6rneklerde ARB g\u00f6r\u00fclmedi, t\u00fcberk\u00fcloz PCR negatif olarak tespit edildi ve mikobakteri k\u00fclt\u00fcr\u00fcnde \u00fcreme olmad\u0131. Ancak al\u0131nan biyopsi \u00f6rne\u011finde gran\u00fclomat\u00f6z infeksiyon saptanmas\u0131, lezyonlar\u0131n\u0131n g\u00f6r\u00fcn\u00fcm\u00fcn\u00fcn t\u00fcberk\u00fclozla uyumlu olmas\u0131, PPD ve IGS testlerinin pozitif saptanmas\u0131 \u00fczerine hastaya d\u00f6rtl\u00fc antit\u00fcberk\u00fcloz (INH 300 mg, RIF 600 mg, ETM 1500 mg, PZA 2000 mg) tedavisi ba\u015fland\u0131. Tedaviyle hastan\u0131n lezyonlar\u0131 gerilemeye ba\u015flad\u0131. Tedavinin ikinci ay\u0131ndan sonra lezyonlar\u0131 tamamen d\u00fczeldi. Hastan\u0131n tedavisi alt\u0131 aya tamamlanarak kesildi (Resim 3B).<\/p>\n

OLGU 4<\/strong><\/h2>\n
\"\"<\/a>

Resim 4.<\/strong> Olgu lezyonlar\u0131n\u0131n tedavi \u00f6ncesi ve sonras\u0131 g\u00f6r\u00fcnt\u00fcleri.<\/p><\/div>\n

Yirmi bir ya\u015f\u0131nda kad\u0131n hasta sol el \u00fcst\u00fcnde yara \u015fikayetiyle poliklini\u011fimize ba\u015fvurdu. \u00d6yk\u00fcs\u00fcnden bu yaran\u0131n alt\u0131 ayd\u0131r oldu\u011fu, ba\u015fvurdu\u011fu sa\u011fl\u0131k kurulu\u015flar\u0131nda tan\u0131 konulamad\u0131\u011f\u0131 ve verilen tedavilerle iyile\u015fmedi\u011fi \u00f6\u011frenildi. Fizik muayenede sol el dorsal y\u00fczde hiperkerotik 3\u00d75 cm boyutlar\u0131nda a\u00e7\u0131k yaras\u0131 mevcuttu, di\u011fer sistem muayeneleri normal olarak de\u011ferlendirildi (Resim 4A). Tetkiklerinde l\u00f6kosit say\u0131s\u0131 6300 h\u00fccre\/mm3<\/sup> (4000-10 000 h\u00fccre\/mm3<\/sup>), hemoglobin 13.3 gr\/dl (12-16 gr\/dl), platelet say\u0131s\u0131 331 000 h\u00fccre\/mm3<\/sup> (150 000-450 000 h\u00fccre\/mm3<\/sup>), ESR 16 mm\/1.saat, CRP 0.2 mg\/dl (0-0.8 mg\/dl) tespit edildi. PPD\u2019si 20 mm saptanan hasta Dermatoloji Klini\u011fiyle kons\u00fclte edilerek lezyondan biyopsi al\u0131nd\u0131. Al\u0131nan \u00f6rnekte ARB g\u00f6r\u00fclmedi, t\u00fcberk\u00fcloz PCR negatif olarak saptand\u0131 ve mikobakteri k\u00fclt\u00fcr\u00fcnde \u00fcreme olmad\u0131. Histopatolojik incelemede lupus vulgaris tan\u0131s\u0131 konulan hastaya d\u00f6rtl\u00fc antit\u00fcberk\u00fcloz (INH 300 mg, RIF 600 mg, ETM 1500 mg, PZA 2000 mg) tedavisi ba\u015fland\u0131. Tedavinin d\u00f6rd\u00fcnc\u00fc ay\u0131nda lezyonlar\u0131 d\u00fczelen hastan\u0131n tedavisi alt\u0131 aya tamamlanarak kesildi (Resim 4B).<\/p>\n

OLGU 5<\/strong><\/h2>\n
\"\"<\/a>

Resim 5. <\/strong>Lezyonlar\u0131n tedavi \u00f6ncesi g\u00f6r\u00fcnt\u00fcs\u00fc.<\/p><\/div>\n

Altm\u0131\u015f dokuz ya\u015f\u0131nda kad\u0131n hasta 2 ay \u00f6nce sol el birinci ve d\u00f6rd\u00fcnc\u00fc parmakta ak\u0131nt\u0131l\u0131 yara olmas\u0131 \u00fczerine Ortopedi ve Travmatoloji Klini\u011fine ba\u015fvurmu\u015f. Deri t\u00fcm\u00f6r\u00fc \u00f6n tan\u0131s\u0131yla hastan\u0131n lezyonlar\u0131ndan biyopsi yap\u0131lm\u0131\u015f. Patoloji sonucunun kazeifiye gran\u00fclomat\u00f6z infeksiyonla uyumlu gelmesi \u00fczerine taraf\u0131m\u0131za y\u00f6nlendirilmi\u015f. Ba\u015fvuru an\u0131nda hastan\u0131n fizik muayenesinde sol el birinci ve d\u00f6rd\u00fcnc\u00fc parmakta yap\u0131lan biyopsiye ba\u011fl\u0131 diki\u015fleri mevcuttu, di\u011fer sistem muayeneleri do\u011fald\u0131 (Resim 5). Tetkiklerinde l\u00f6kosit say\u0131s\u0131 8100 h\u00fccre\/mm3<\/sup> (4000-10 000 h\u00fccre\/mm3<\/sup>), hemoglobin 12.9 gr\/dl (13-16 gr\/dl), platelet say\u0131s\u0131 302 000 h\u00fccre\/mm3<\/sup> (150 000-450 000 h\u00fccre\/mm3<\/sup>), ESR 14 mm\/1.saat, CRP 1.34 mg\/dl (0-0.8 mg\/dl) tespit edildi. Hastan\u0131n ba\u015fvurusu s\u0131ras\u0131nda Ortopedi ve Travmatoloji Klini\u011fi taraf\u0131ndan deri t\u00fcm\u00f6r\u00fc \u00f6n tan\u0131s\u0131yla biyopsi yap\u0131ld\u0131\u011f\u0131 i\u00e7in al\u0131nan \u00f6rnekten ARB, t\u00fcberk\u00fcloz PCR ve mikobakteri k\u00fclt\u00fcr\u00fc g\u00f6nderilmedi\u011fi saptand\u0131. PPD\u2019si 21 mm olan ve patoloji sonucu kazeifiye gran\u00fclomat\u00f6z infeksiyonla uyumlu gelen hastaya d\u00f6rtl\u00fc antit\u00fcberk\u00fcloz (INH 300 mg, RIF 600 mg, ETM 1500 mg, PZA 2000 mg) tedavi ba\u015fland\u0131. Hasta tedavisinin yirminci g\u00fcn\u00fcndedir ve tedavisi devam etmektedir.<\/p>\n

\u0130RDELEME<\/strong><\/h2>\n

Deri t\u00fcberk\u00fclozu, lezyonlar\u0131n spesifik olmayan klinik \u00f6zellikleri nedeniyle tan\u0131 koyman\u0131n zor oldu\u011fu nadir bir t\u00fcberk\u00fcloz formudur. Deri t\u00fcberk\u00fclozunun lezyonlar\u0131 bir\u00e7ok hastal\u0131kla kar\u0131\u015fabilen \u00e7e\u015fitli klinik \u00f6zellikler g\u00f6sterir ve basil y\u00fck\u00fc d\u00fc\u015f\u00fckt\u00fcr. Ancak uzun s\u00fcredir iyile\u015fmeyen ve temel antibakteriyel tedavilere cevap vermeyen cilt lezyonlar\u0131 bulunan olgularda ay\u0131r\u0131c\u0131 tan\u0131da mutlaka akla gelmesi gereken bir cilt infeksiyonudur (4,5).<\/p>\n

T\u00fcberk\u00fclin deri testi (PPD) ve IGS testi gibi imm\u00fcnolojik testler, hastan\u0131n ge\u00e7mi\u015fte M. tuberculosis<\/em>\u2019e maruz kald\u0131\u011f\u0131n\u0131 g\u00f6sterir, ancak aktif hastal\u0131\u011f\u0131 g\u00f6stermez (6). Histopatolojik de\u011ferlendirmede t\u00fcberk\u00fcloid gran\u00fclomlar, lenfositler, Langhans tipi dev h\u00fccreler ve kaze\u00f6z nekroz g\u00f6r\u00fclmesi t\u00fcberk\u00fcloz i\u00e7in tipiktir (5). Olgular\u0131m\u0131z\u0131n hepsinde t\u00fcberk\u00fclin deri testi pozitif olarak saptanm\u0131\u015ft\u0131r. \u0130nterferon \u03b3-sal\u0131n\u0131m testi ise \u00fc\u00e7 hastam\u0131zda pozitif saptanm\u0131\u015ft\u0131r. \u0130ki hastam\u0131za ise bu tetkik yap\u0131lamam\u0131\u015ft\u0131r. Olgular\u0131m\u0131z\u0131n hepsinin tan\u0131s\u0131 histopatolojik incelemeyle konulmu\u015ftur.<\/p>\n

Deri t\u00fcberk\u00fclozunun tan\u0131s\u0131nda histopatolojik \u00f6rnekte M. tuberculosis<\/em>‘in saptanmas\u0131 \u00f6nemlidir. Ancak d\u00fc\u015f\u00fck basil y\u00fck\u00fc nedeniyle \u00e7o\u011fu zaman ARB pozitifli\u011fi g\u00f6sterilememektedir (7). Olgular\u0131m\u0131z\u0131n hepsinde ARB negatif olarak saptand\u0131. Bu durum deri t\u00fcberk\u00fclozlar\u0131nda basil y\u00fck\u00fcn\u00fcn d\u00fc\u015f\u00fck olmas\u0131yla ili\u015fkilendirilmi\u015ftir.<\/p>\n

K\u00fclt\u00fcrde M. tuberculosis<\/em>‘in izolasyonu tan\u0131da alt\u0131n standartt\u0131r. Ancak uzun s\u00fcrede sonu\u00e7lan\u0131r ve her zaman \u00fcreme g\u00f6r\u00fclmeyebilir (8). T\u00fcberk\u00fcloz tan\u0131s\u0131nda en s\u0131k kullan\u0131lan iki k\u00fclt\u00fcr sistemi; L\u00f6wenstein-Jensen (LJ) besiyeri ve otomatize t\u00fcberk\u00fcloz k\u00fclt\u00fcr sistemi (BACTEC\u00ae<\/sup>, Bact-ALERT\u00ae<\/sup> vb)’dir. Yap\u0131lan \u00e7al\u0131\u015fmalarda duyarl\u0131l\u0131klar\u0131n s\u0131ras\u0131yla LJ besiyeri i\u00e7in %6-14, t\u00fcberk\u00fcloz BACTEC\u00ae<\/sup> sistemi i\u00e7inse %55-62.8 aras\u0131nda oldu\u011fu g\u00f6sterilmi\u015ftir. Ayr\u0131ca k\u00fclt\u00fcr sonu\u00e7lar\u0131, ila\u00e7 direncinin saptanmas\u0131 a\u00e7\u0131s\u0131ndan \u00f6nemlidir (5). Hastanemizde mikobakteri k\u00fclt\u00fcr\u00fc i\u00e7in t\u00fcberk\u00fcloz BACTEC\u00ae<\/sup> sistemi kullan\u0131lmaktad\u0131r. Bizim olgular\u0131m\u0131z\u0131n 1\u2019ine k\u00fclt\u00fcr yap\u0131lamam\u0131\u015ft\u0131r. K\u00fclt\u00fcr yap\u0131lan 4 olgunun 3\u2019\u00fcnde \u00fcreme olmam\u0131\u015f, 1\u2019inde ise M. tuberculosis <\/em>complex \u00fcremi\u015ftir ve ila\u00e7 direnci saptanmam\u0131\u015ft\u0131r. K\u00fclt\u00fcrde \u00fcreme oran\u0131n\u0131n d\u00fc\u015f\u00fck olma nedeni deri t\u00fcberk\u00fclozlar\u0131nda basil y\u00fck\u00fcn\u00fcn d\u00fc\u015f\u00fck olmas\u0131yla ili\u015fkilendirilmi\u015ftir.<\/p>\n

DNA amplifikasyon teknikleri kullan\u0131larak M. tuberculosis<\/em> genomunun saptanmas\u0131 tan\u0131da etkili ve h\u0131zl\u0131 bir y\u00f6ntemdir. Bu teknikle az miktarda mikobakteri genomu bile saptanabilir ancak mikobakterilerin d\u00fczensiz da\u011f\u0131l\u0131m\u0131 ve doku \u00f6rneklerindeki inhibit\u00f6r maddelerin varl\u0131\u011f\u0131 nedeniyle sensitivitesi d\u00fc\u015f\u00fckt\u00fcr (9). Bizim d\u00f6rt olgumuzun t\u00fcberk\u00fcloz PCR sonucu negatif gelmi\u015ftir, bir hastam\u0131zdan bu tetkik istenememi\u015ftir.<\/p>\n

Genel olarak, deri t\u00fcberk\u00fclozunun tedavisi, iki ay d\u00f6rtl\u00fc rejim (izoniazid, rifampisin, pirazinamid ve etambutol) ard\u0131ndan d\u00f6rt ay ikili rejim (izoniazid ve rifampisin) olmak \u00fczere alt\u0131 ayd\u0131r (8). \u0130la\u00e7 toksisitesinin ve hasta uyumunun izlenmesi \u00e7ok \u00f6nemlidir (10). Olgular\u0131m\u0131za standart antit\u00fcberk\u00fcloz tedavisi uyguland\u0131. Hastalar yak\u0131n takibe al\u0131narak tedavi uyumu ve ila\u00e7 yan etkileri a\u00e7\u0131s\u0131ndan de\u011ferlendirildi. D\u00f6rt olgunun tedavisi tamamland\u0131. Bir olgunun tedavisi devam etmektedir.<\/p>\n

Sonu\u00e7 olarak; deri t\u00fcberk\u00fclozu farkl\u0131 klinik \u00f6zellikler g\u00f6sterir ve bir\u00e7ok hastal\u0131kla kar\u0131\u015ft\u0131r\u0131labilmektedir. Atipik cilt lezyonlar\u0131 olan hastalarda deri t\u00fcberk\u00fclozu mutlaka ak\u0131lda tutulmal\u0131 ve buna y\u00f6nelik tetkikler istenmelidir. Deri t\u00fcberk\u00fclozu tedavisi uzun ve zorlu bir s\u00fcre\u00e7tir. Hastalar yak\u0131ndan takip edilmelidir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e T\u00fcberk\u00fcloz, Mycobacterium tuberculosis\u2019in neden oldu\u011fu t\u00fcm organ ve dokular\u0131 tutabilen bir infeksiyon hastal\u0131\u011f\u0131d\u0131r. Ekstrapulmoner t\u00fcberk\u00fcloz, primer infeksiyon s\u0131ras\u0131nda lenfohematojen yolla di\u011fer organlara yay\u0131lan ve latent kalan t\u00fcberk\u00fcloz basilinin hayat\u0131n herhangi bir d\u00f6neminde reaktive olmas\u0131yla geli\u015fmektedir. T\u00fcberk\u00fcloz lenfadenit ve plevra t\u00fcberk\u00fclozu ekstrapulmoner t\u00fcberk\u00fclozun en s\u0131k g\u00f6r\u00fclen formlar\u0131d\u0131r (1-3). Deri t\u00fcberk\u00fclozlar\u0131 ise %1-1.5 g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131yla ekstrapulmoner […]<\/p>\n","protected":false},"author":3,"featured_media":22591,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5131],"tags":[5184,5183,3716,3717,4580],"class_list":["post-22069","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-olgu-sunumu","tag-cilt-hastaliklari","tag-kutanoz-tuberkuloz","tag-tani","tag-tedavi","tag-yumusak-doku-infeksiyonlari"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22069","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=22069"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22069\/revisions"}],"predecessor-version":[{"id":22882,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22069\/revisions\/22882"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/22591"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=22069"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=22069"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=22069"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}