An Unusual Presentation of Lupus Vulgaris and the Practical Usefulness of Dermatoscopy

Abstract

We report a case report of lupus vulgaris (LV) presented on the extremities of an 80-year-old man. He was misdiagnosed as having psoriasis and referred to our department for a second-opinion evaluation. The discrepancy between the clinical manifestation which was misleading and the dermatoscopic findings raised the suspicion of an underlying granulomatous disease and we proceeded to skin biopsy. The histopathologic examination set the diagnosis of LV.

A Case of Cutaneous Tuberculosis Presenting As Lupus Vulgaris in an Immunocompetent Indian Child During the Pandemic of COVID-19

“…Lupus vulgaris is an infrequently reported, chronic, progressive type of TB due to an incessant spread from an intrinsic focus or by hematogenous or lymphatic spread or rarely from exogenous sources (biologic liquids) such as infectious droplets [8]. Lupus vulgaris is predominantly reported in young adults on the face and neck [8]. The situation becomes difficult when the lesions are present in other body parts [8].…”

“…Lupus vulgaris is predominantly reported in young adults on the face and neck [8]. The situation becomes difficult when the lesions are present in other body parts [8]. Facial involvement is commonly seen in western countries but in India, buttocks and extremities are commonly affected [5].…”

“…Facial involvement is commonly seen in western countries but in India, buttocks and extremities are commonly affected [5]. An asymptomatic scaly plaque developed by coalescing red-brown papules with a soft consistency termed lupoma is the characteristic of lupus vulgaris [8,10]. The plaque progresses gradually with the peripheral development of new papules [8].…”

“…An asymptomatic scaly plaque developed by coalescing red-brown papules with a soft consistency termed lupoma is the characteristic of lupus vulgaris [8,10]. The plaque progresses gradually with the peripheral development of new papules [8]. A pale brownish-yellow or "apple-jelly" color on blanching by diascopic pressure is observed on the lesions [8].…”

“…An absolute criterion involves identifying M. tuberculosis from a positive result on polymerase chain reaction (PCR), tissue culture, or inoculation on guinea pigs [6,7]. However, due to the paucibacillary nature of cutaneous TB, it is a formidable task [8]. Therefore, a relative criterion is also available that includes a detailed history and assessment of lesions, finding of an acid-fast bacillus (AFB) on lesions, active TB found on other organs, finding of a tuberculous granuloma on histopathological examination, positive tuberculin test, and responsiveness toward anti-TB medications [7].…”