A common but underreported entity of papulonecrotic tuberculid

Sinha, Preema; Sinha, Anamika; Baveja, Sukriti; Sood, Aradhana Bela

doi:10.1016/j.mjafi.2014.04.018

Cited by 3 publications

(7 citation statements)

References 8 publications

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“…Systemic features that may be associated include lymphadenopathy, leukocytoclastic vasculitis, and ocular complications, such as conjunctivitis and uveitis. 3,4 Clinical differentials in the appropriate contexts may include pityriasis lichenoides et varioliformis acuta, sarcoidosis, Sweet syndrome, polymorphic light eruption, hydroa vacciniforme, perforating granuloma annulare, folliculitis, arthropod bite reactions, secondary syphilis, lymphomatoid papulosis, drug eruptions, and cutaneous lymphomas or metastases.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Papular Eruption: Answer

Koh

Kwah²,

Tee

2022

The American Journal of Dermatopathology

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The patient had papulonecrotic tuberculid as evidenced by a granulomatous dermal infiltrate seen in a biopsy from the erythematous papulonecrotic eruption. Interferon-gamma release assay (QuantiFERON Gold Plus, QIAGEN) was performed and found to be positive (TB1 4.23 IU/mL, TB2 5.52 IU/mL, and mitogen 6.34 IU/mL), indicating tuberculosis infection. The patient declined further invasive investigations to evaluate her cervical lymphadenopathy. She has since commenced antituberculous treatment with the improvement of her skin lesions and continues to follow-up at the National Tuberculosis Control Unit in Singapore.

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Section: Discussionmentioning

confidence: 99%

Recurrent Papular Eruption: Answer

Koh

Kwah²,

Tee

2022

The American Journal of Dermatopathology

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“…The concept of tuberculid was introduced in 1896 by Darier, as representing a form of cutaneous hypersensitivity reaction to TB antigens. Later in 1936, Pautrier established PNT as a distinct TB‐associated skin entity, and described its characteristic clinical and histopathological features 4 …”

Section: Historymentioning

confidence: 99%

“…There are cases of PNT associated with erythema nodosum, limb gangrene, Takayasu arteritis, arthritis, uveitis, optic neuritis, phlyctenular conjunctivitis, discoid lupus erythematosus, leucocytoclastic vasculitis, lymphadenopathy and Hodgkin lymphoma reported in the literature 4,5,25–27 …”

Section: Associationmentioning

confidence: 99%

“…Later in 1936, Pautrier established PNT as a distinct TB-associated skin entity, and described its characteristic clinical and histopathological features. 4…”

Section: Historymentioning

confidence: 99%

“…23,24 There are cases of PNT associated with erythema nodosum, limb gangrene, Takayasu arteritis, arthritis, uveitis, optic neuritis, phlyctenular conjunctivitis, discoid lupus erythematosus, leucocytoclastic vasculitis, lymphadenopathy and Hodgkin lymphoma reported in the literature. 4,5,[25][26][27] et varioliformis acuta, lichen urticatus, insect bite, pruritus, prurigo, necrotizing leucocytoclastic vasculitis, suppurative folliculitis, secondary syphilis, miliary TB, infectious causes of palisade granuloma, perforating dermatoses and perforating granuloma annulare. 1,3,9,27 The salient clinical and histopathological features of diseases that can mimic PNT are shown in Table 1, and the differences between the various tuberculids are shown in Table 2.…”

Section: Associationmentioning

confidence: 99%

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Papulonecrotic tuberculid

Palaniappan

Sadhasivamohan

Karthikeyan

2022

Clinical and Experimental Dermatology

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A 30-year-old man presented with a 6 year history of recurrent, multiple asymptomatic raised lesions over his back and bilateral upper limbs. He had been treated repeatedly for a case of recurrent boils with oral and topical antibiotics. Some of the lesions had healed spontaneously leaving behind unsightly scars. The patient denied any history of associated fever, chronic cough, weight loss, and drug intake prior to the onset of lesions. There was no recognized contact with tuberculosis patients. General and systemic examination was essentially normal. Dermatological examination revealed the presence of multiple, well-defined, hyperpigmented crusted papules of 0.5-1.0 cm in size, distributed symmetrically over his entire back, extensor surface of bilateral forearm, arm, and bilateral dorsum of foot, interspersed with atrophic varioliform scarring (Figures 1 and 2). Routine laboratory workup was normal. Tuberculin (Mantoux) was strongly positive at 72 hours (23 × 23 mm) with central necrosis (Figure 3). Sputum for acid fast bacilli culture, chest radiograph, ultrasound abdomen, and pelvis did not reveal any abnormality. A biopsy specimen taken from a crusted papule over his forearm (Figure 4) showed fibrinoid necrosis, surrounded by mixed inflammatory infiltrate filling the entire dermis along with a few ill-defined epitheloid granulomas and lymphocytoclastic vasculitis. These are consistent with papulonecrotic tuberculid.The patient was started on a four drug combination therapy of rifampicin, isoniazid, pyrazinamide, and ethambutol for two months initially followed by a combination of rifampicin and isoniazid to complete a total of 6 months of standard antitubercular therapy. The patient responded well and all of the lesions eventually healed.

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