Sir, Childhood cutaneous tuberculosis may constitute 18.7-53.9% of all cutaneous tuberculosis cases. Majority of such cases are seen in children aged 10-14 years and most common clinical type of cutaneous tuberculosis is scrofuloderma, followed by lupus vulgaris. Lupus vulgaris in children is mostly seen on trauma prone parts, usually on legs, knees, thighs, buttocks and feet. [1] However, other sites too may be affected, depending upon the site of inoculation of infective agent. For example, lupus vulgaris at Bacillus Calmette-Guérin (BCG) vaccination site is well-known. [2] We report a case of the young girl presenting with lupus vulgaris of both ear following ear piercing.
An 8-month-old female infant presented with vesicular lesions on the right lower extremity for 2 days. There were grouped vesicles on an erythematous base over right leg, dorsum of right foot and sole, distributed in the L5 and S1 dermatomes (Fig 1). The baby was irritable, but afebrile. The baby was born at term and by normal vaginal delivery and her birth weight was 2.5 kg. Postnatal period was uneventful. Her developmental milestones were within normal range. There was history of maternal varicella infection during 3rd months of pregnancy. Tzanck smear from the lesions showed mononuclear and multinucleated acantholytic cells with ground glass nuclei, consistent with Tzanck cells. Based on history and clinical findings, diagnosis of Herpes zoster was made. The infant was treated symptomatically with topical calamine lotion and oral antipyretic. The lesions crusted in 1 week and resolved completely in 2 weeks, without any sequelae.Herpes Zoster (HZ) results from reactivation of varicella Zoster virus (VZV) that entered the cutaneous nerves during an earlier episode of chickenpox, traveled to the dorsal root ganglia, and remained in a latent form. Age, immunosuppressive drugs, lymphoma, fatigue, emotional upsets, and radiation therapy have been implicated in reactivation of the virus, which subsequently travels back down the sensory nerve, infecting the skin. Reactivation of latent VZV infection is very rare in childhood, more so in infants. Infantile HZ is more commonly associated with intrauterine VZV infection than postnatal infection. HZ in children is considered common in immunocompromised babies, but can occur in immunocompetent children as well. The diagnosis can usually be made on clinical grounds. Tzanck smear may support the clinical diagnosis. The differential diagnoses are zosteriform herpes simplex infection (no radiating pain, small vesicles of almost uniform size, less number of groups of vesicles, and more likely to recur) and contact dermatitis (history of contact, and presence of papules, pustules, scaling and/ or epidermal necrosis). HZ is a self-limited cutaneous eruption in children and treatment usually consists of supportive care with antihistamines and antipruritic agents. Systemic antiviral drug is usually recommended in severe disseminated VZV infection, ophthalmic VZV infection and in immunocompromised patients.
No abstract
A 9-year-old boy presented with asymptomatic, skin colored, grouped papules with mild scaling on elbows, buttocks, knees, and dorsa of feet in a bilateral symmetric manner for 8 months (Fig. 1). There were no systemic features and boy appeared otherwise healthy. Family history was non-contributory. Mantoux text was positive (20 X 24 mm); routine blood investigations, chext X-ray and abdominal ultrasonography were normal. Histopathological findings were consistent with lichen scrofulosorum (Fig. 2). He showed almost complete resolution of lesions after four months of anti-tubercular therapy.
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