Disseminated Lupus Vulgaris and Papulonecrotic Tuberculid: Case Report

Şenol, Mustafa; Özcan, Atilla; Aydın, Abdullah; Karincaoglu, Yelda; Şaşmaz, Sezai; Şener, Serpil

doi:10.1046/j.1525-1470.2000.01730.x

Cited by 30 publications

(23 citation statements)

References 9 publications

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“…The condition typically follows a prolonged and relapsing course lasting years although spontaneous resolution has been reported. Progression to lupus vulgaris has been observed [1,2]. PNT has been reported to coexist with the lesions of erythema induratum [5,6] as well as lichen scrofulosorum [7].…”

Section: Resultsmentioning

confidence: 99%

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Papulonecrotic Tuberculid with Scrofuloderma: An Uncommon Association

Gupta

2015

JCDR

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A 35-year-old male presented to our institution with one year history of asymptomatic, dark coloured elevated lesions over trunk and both extremities, with two month history of painless, discharging sinus in the right axilla. Lesions first started as asymptomatic, skin coloured to erythematous papules over both knees and elbows which subsequently developed necrosis and crusting in the centre and healed with pitted scarring. New crops of lesions continued to appear over a period of one year with predominant involvement of the extremities and few lesions scattered over trunk. Each crop of lesions healed rapidly with central crusting and atrophic scarring. Ten months after the onset of skin lesions, he developed a painless non tender, 2x2cm sized nodule over right axilla which ruptured within 15 d forming a sinus with serosanguinous discharge. There was no personal or family history of tuberculosis.Examination revealed dusky red to brown coloured pea sized necrotizing papules along with atrophic varioliform scars present symmetrically over trunk and extremities, with predilection for knees and elbows [Table/ Fig-1]. A 2x2 cm sized firm, non tender, subcutaneous indurated nodule was seen in the right axillary area, with central discharging sinus having bluish undermined edges [Table /Fig-2]. aBstRaCtCutaneous tuberculosis can be classified as true cutaneous tuberculosis and tuberculids which is regarded as a hypersensitivity reaction to M. tuberculosis in patients with a high degree of tuberculin sensitivity. Papulonecrotic tuberculid (PNT) is a form of tuberculid. It is an uncommon manifestation even in areas with high prevalence of tuberculosis.We report a case of 35-year-old man who presented with necrotizing papules in symmetrical fashion over the trunk and extremities for last one year along with a discharging sinus in right axilla for last two months. Papulonecrotic tuberculid (PNT) with scrofuloderma were suspected on clinical examination. Mantoux test was strongly positive with 20x20mm. He was treated successfully with ATT without any further appearance of new lesions.

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Section: Resultsmentioning

confidence: 99%

“…Other areas which may rarely be affected are buttocks, face, eyelids and glans penis. A focus of tuberculosis elsewhere in the body may not be demonstrable in majority of the cases with PNT, however cases have been reported where PNT was associated with lupus vulgaris [1,2].…”

Section: Discussionmentioning

confidence: 99%

Papulonecrotic Tuberculid with Scrofuloderma: An Uncommon Association

Gupta

2015

JCDR

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“…The differential diagnosis of LV includes sarcoidosis, lymphocytoma cutis, discoid lupus erythematosus, tertiary spyhilis, leprosy, blastomycosis, lupoid leishmaniasis, and chronic vegetative pyodermas. 3,5 Cutaneous tuberculosis is diagnosed with medical history, clinical, histological findings, positivity of PPD, Ziehl-Neelsen staining, culture and polymerase chain reaction results. [2][3][4][5][6]8 A diagnosis of LV in our patient was based on clinical, histopathological findings and positivity of PPD.…”

Section: Discussionmentioning

confidence: 99%

“…In very rare instances, LV may present with multiple lesions. [1][2][3][4][5][6] Here, we describe a case of multifocal lupus vulgaris.…”

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Multifocal Lupus Vulgaris: Case Report

Ferahbaş¹,

Çölgeçen²,

Borlu³

et al. 2012

Turkiye Klinikleri J Med Sci

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1766upus vulgaris (LV) is the most common, post-primary; highly destructive form of cutaneous tuberculosis in a patient with intact immunity. Women are twice as likely to be affected as men. LV may appear at sites of inoculation, in scrofuloderma scars, after Bacille CalmetteGuerin (BCG) vaccination, or most commonly at distant sites from the initial infectious focus. LV is associated with moderately high immunity to tuberculosis; most patients will have a positive tuberculin test. In approximately 90% of the patients, the head and neck are involved. It usually presents as a solitary lesion. In very rare instances, LV may present with multiple lesions.1-6 Here, we describe a case of multifocal lupus vulgaris. Multifocal Lupus Vulgaris: Case ReportA AB BS ST TR RA AC CT T Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis and primarily seen in the developing countries. Lupus vulgaris is a chronic progressive form of cutaneous tuberculosis that occurs in individuals with a moderate to high degree of immunity, and usually presents as a solitary lesion on the head and the neck. In this paper, lupus vulgaris is reported in a 29-yearold woman who had a 7-year history of plaques first beginning on her left arm and then spreading to her trunk, back and left retroauricular area. The diagnosis of lupus vulgaris was based on clinical, histopathological findings and purified protein derivative (PPD) positivity. No acid-fast bacilli were detected by Ziehl-Neelsen staining. Culture of biopsy specimens and polymerase chain reaction were negative for M. tuberculosis. She had antituberculous therapy with three drugs and her lesions responded rapidly to this therapy.

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“…It is characterized by plaque with apple-jelly nodule that extends irregularly with scar formation and tissue destruction [2]. Differential diagnosis of lupus vulgaris is also difficult and unreliable purely on clinical grounds, and histopathological and microbiological examinations are required [3].…”

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Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis

Afşar¹,

Afşar²,

Diniz³

et al. 2008

Braz J Infect Dis

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Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 10-year-old boy who was diagnosed as lupus vulgaris clinically and histopathologically. He had well demarcated, irregularly bordered, pink, infiltrated plaques on his left cheek showing apple-jelly appearance on diascopy. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux reactivity was in normal limits, and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed marked improvement on anti-tuberculosis treatment. We want to emphasize that histopathological examination has diagnostic value in lupus vulgaris in correlation with clinical appearance, when direct analysis or culture is negative.

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Disseminated Lupus Vulgaris and Papulonecrotic Tuberculid: Case Report

Cited by 30 publications

References 9 publications

Papulonecrotic Tuberculid with Scrofuloderma: An Uncommon Association

Papulonecrotic Tuberculid with Scrofuloderma: An Uncommon Association

Multifocal Lupus Vulgaris: Case Report

Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis

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