PPD sonrası gelişen atipik büllöz reaksiyon: Tüberküloz lenfadenit olgu sunumu

Abstract

Tüberkülozun tanısında en eski ve en sık kullanılan tüberküloz tarama testi, saflaştırılmış bir protein türevinin (pürifiye protein derivesi = PPD) deri içine enjekte edildiği uygulamadır. PPD uygulanan böl-gede 48-72 saat içinde sertleşme, gecikmiş tipte aşırı duyarlılık reaksiyonunu ve M. tuberculosis ile enfeksiyonu gösterir. Bu yazıda aynı gün içinde aynı koldan PPD ve COVID-19 Biontech aşılaması yapılan ve PPD enjeksiyon bölgesinde atipik büllöz reaksiyon gelişen bir olgu sunulmuştur. PPD ve COVID-19 aşılamalarının aynı gün aynı kola uygulandığı olgularda benzer klinik bulguların gelişebile-ceği akılda tutulmalı, bu iki işlemin mümkün olduğunca farklı zamanlarda uygulanmasına dikkat edilmelidir.

Keywords

• PPD
• atipik büllöz reaksiyon
• tüberküloz
• COVID-19 aşı

Atypical bullous reaction after PPD: A case report of tuberculous lymphadenitis

Abstract

The oldest and most commonly used tuberculosis screening test in the diagnosis of tuberculosis is the application in which a purified protein derivative (purified protein derivative = PPD) is injected into the skin. Hardening in the PPD treated area within 48-72 hours indicates delayed-type hypersensitivity reaction and infection with M. tuberculosis. In this article, a case who was injected with PPD and COVID-19 Biontech from the same arm on the same day and who developed an atypical bullous reaction at the ppd injection site is presented. It should be kept in mind that similar clinical findings may deve-lop in cases where PPD and COVID-19 vaccinations are applied to the same arm on the same day, and care should be taken to apply these two procedures at different times as much as possible.

Keywords

• PPD
• atypical bullous reaction
• tuberculosıs
• COVID-19 Vaccine

References

1. 1. World Health Organization. Tuberculosis. Available online: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
2. 2. Amerikan Toraks Derneği Yetişkinlerde ve çocuklarda tüberkülozun tanı standartları ve sınıflandırılması . Am J Respir Crit Care Med 2000; 2013 :1376–95
3. 3. Fitzgerald D W, Sterling T R, Haas D W. Mycobacte-rium Tuberculosis (Tuberculin Skin Test). In: Mandell GL, Bennett JE, Dolin R (Eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infec-tiousDiseases, 9th ed. Philadelphia, 2020, pp:2994-5.
4. 4. Pahal, P.; Sharma, S. PPD Skin Test (Tuberculosis Skin Test). In StatPearls; StatPearls Publishing: Treasure Is-land, FL, USA, 2020
5. 5. Almeida Santos J, Duarte R, Nunes C. Tuberculin skin test and predictive host factors for false-negative results in patients with pulmonary and extrapulmonary tubercu-losis. Clin Respir J. 2020 Jun;14(6):541-548.
6. 6. Rehman MU, Bibi S, Imran. Khan Z, Khan AS, Hussain Gilani SY, Baig M. Role Of Tuberculin Test As A Diag-nostic Tool For Tuberculosis. J Ayub Med Coll Abbotta-bad. 2018 Oct-Dec;30(4):529-533.
7. 7.Tuberculin purified protein derivative (Mantoux) Tu-bersol® Diagnostic Antigen. Aventis Pasteur, Swiftwater, Pa. http://www.vaccineshoppe.com/US_PDF/752–21_4611.pdf (accessed Jul 5 2007)
8. 8. Blossom AP, Cleary JD. Atypical tuberculosis skin test reaction. Ann Pharmacother 2003;2013:451

9. 9. Khan UH, Koul PA.A young 20-year-old woman with an atypical tuberculin reaction. Case Re-ports 2013;2013:bcr2013010500.
10. 10. Goraya JS, Virdi VS: Bacille Calmette-Guérin lymp-hadenitis. Postgrad Med J 2002; 78: pp. 327-329.
11. 11. Comstock GW. Field trials of tuberculosis vaccines: How could we have done them better? Controlled Clini-cal Trials 1994; 15: 247-76.
12. 12. WHO Technical Report Series 1987, No:745, Annex I, p:31-59.
13. 13.Sampaio E P, Duppre N C, Nery J A, Moreira A L, Sarno E N. Development of giant reaction in response to PPD skin test in lepromatous leprosy patients. 1993 Jun;61(2):205-13.
14. 14.https://www.consultant360.com/content/atypical-tuberculin-skin-test-responses
15. 15. Dim Bunnet MD, Alexandra Kerleguer MD, Peou Kim MD et al. Necrotic Tuberculin Skin (Mantoux) Test Reaction. Chest, 2015-07-01, Volume 148, Issue 1, Pages e1-e4, Copyright © 2015 The American College of Chest Physicians
16. 16. Nicolás-Sánchez FJ, Moreno-Arias G, Cabau-Rubies J: Tuberculin skin test with an atypical blistering reac-tion. Arch Bronconeumol 2006; 42: pp. 100.
17. 17. Varma C, Aroor S, Mundkur SC: An atypical giant Mantoux reaction. Our Dermatol Online 2012; 3: pp. 234.
18. 18. Menzies D, Tannenbaum TN, FitzGerald JM: Tubercu-losis: 10. Prevention. CMAJ 1999; 161: pp. 717-724.