Cutaneous tuberculosis incidence was recorded as 0.15%. Of the 42 patients, 23 had scrofuloderma, 17 lupus vulgaris, and 2 tuberculosis verrucosa cutis. Both men and women were affected by the disease in the second and third decades. Its duration was variable. An affirmative family history was elicited in five scrofuloderma patients. The clinical expression largely conformed to the ritual text. Variation in Mantoux test positivity was unremarkable. The disparity in the demonstration of bacilli in the smear and tissue sections was, however, quite apparent in scrofuloderma. The correlation of different parameters indicates a continuous spectrum, formed at one end by lupus vulgaris, and at another by scrofuloderma. A moderate to strongly positive Mantoux text, enormous lymphocytes in the granuloma, absence of tubercle bacilli, negative culture, and an apparently normal immunoprofile were features of lupus vulgaris; whereas scrofuloderma had a moderately positive Mantoux test, lesser number of lymphocytes in the granuloma, large number of bacilli in tissue smear and/or tissue section, raised levels of immunoglobulins, and a grossly lowered C3 levels. The other variants probably occupy a position in between.
Psoriasiform reaction pattern is a commonly encountered denominator in a wide variety of unrelated disorders. It may be a reaction to either the internal or the external environmental, allergic, infective, parasitic, bacterial, fungal, viral and/or malignant stimuli. The degree of evolution of such a pattern and its significance vary according to the dermatosis. The age of the skin lesions may also influence the histopathological presentation and its clinico-histopathological disparity can often bewilder an expert. However, such a situation warrants more astute and sustained observations to unveil the exact underlying condition(s). Thus, psoriasiform dermatoses should only be an initial caption until an exact dermatological disorder is defined. There has been greater number of instances of psoriasiform drug eruptions where a confirmation of the diagnosis can be achieved after their remission by doing a provocation test. Similarly, such instances have also been on the rise in HIV/AIDS-affected individuals all over the world. Besides mycosis fungoides and Hodgkin's disease, several unrelated malignancies have been preceded or accompanied by psoriasiform skin eruptions.
A case of high resistant tuberculoid leprosy in a 25-year-old female, developing after small-pox vaccination is described. This case supports the hypothesis of inoculation leprosy.
Complement components C1q and C4 of classic pathway; C3d, a breakdown product of C3, and factor B of alternate pathway: and C3, a component both of classic and alternate pathways, were studied in 35 patients, comprising 18 type I (Lepra) and 17 type II (ENL) reactions. There was a significant decrease in C3 and factor B with a concomitant rise of C3d during ENL. These changes indicate their preeminent role in immunogenesis of type II (ENL) reaction. The changes in the classic pathway components, on the other hand, were insignificant, apparently suggesting its limited involvement in ENL. Furthermore, reversion of factor B and C3d after subsidence of reaction is intriguing and may indicate that they are not substantially affected even with contemporary treatment. Complement components, of both classic and alternate pathways, showed no significant alterations either during type I (Lepra) reaction or after its amelioration.
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