NODULAR GRANULOMATOUS PHLEBITIS OF THE SKIN - A 4TH TYPE OF TUBERCULID

We present five cases of granulomatous phlebitis of the skin and compa re them with a case of miliary tuberculosis with granulomatous phlebit is. All five patients were hypersensitive to purified protein derivati ve, but without active tuberculosis, Although anti-tuberculous drugs w ere effective, no tubercle bacilli were isolated from the skin, Clinic ally, subcutaneous nodules were felt along the course of the leg vein. Histologically, epithelioid cell granulomas with Langhans' giant cell s were observed within the walls of the cutaneous veins, In a later st age, granulomatous panniculitis was often associated, Using the polyme rase chain reaction method, Mycobacterium tuberculosis DNA was detecte d in four of the five cases of granulomatous phlebitis of the skin, Gr anulomatous phlebitis of the skin seems to represent a relatively earl y phase of delayed-type hypersensitivity reactions to Mycobacterium tu berculosis and may represent a distinct entity different from other ty pes of tuberculid-a new tuberculid, Nevertheless, before malting the d iagnosis, the possibility of true tuberculosis must always be excluded , Nodular granulomatous phlebitis of the skin would be an appropriate name for the newly described condition.