Epithelioma complicating lupus vulgaris necessitating forequarter amputation

Abstract

THE development of an epithelioma is a well-recog-ni2e-j complication of lupus vulgaris. T h e treatment of is surgical excision of the epithelioma, the administration of calciferol and antibiotics for the lupus-The operation is usually quite straightforward, but the following case presented unusual difficulties because the primary lesion was extensive treatment. At the age of 21 she sustained a mild blow on the right breast and soon afterwards a patch of lupus developed at the site of injury. This lesion, after ulcer, which was treated by her own doctor with local applicauons of old tuberculin. For the next Seventeen years the patient attended hospital and received various forms of treatment, including applications of pyrogallol, intradermal injections of iodized moogrol, injections of followed if necessary by skin-grafting, together with remaining dry for a year Or a weeping A B C FIG. 594.-A, Axillary lymph-node showing an area of keratinizing epithelioma above and tuberculous lymphadenitis below. 6, High-power view of epitheliomatous area showing cell nests ; four mitotic figures can be seen in the field. H. and E. ( x 24.) ( x 150.) C, High-power view of tuberculous area showing typical tuberculous follicles in lymphoid tissue. x 1 5 0 .and awkwardly situated, and metastases were present in the regional lymph-nodes. The case also had interesting pathological features in that a rapidly growing, metastasizing tumour was combined with a n active tuberculous process, both in the skin and i n the lymph-nodes. CASE REPORTThe patient, a single woman of 49, developed lupus vulgaris on the nose and left cheek when 3 years old. This was treated with tar ointment and a proprietary preparation, Zambuk. Six years later the condition was still active and X-ray therapy was started. There was temporary improvement, but at the age of 11 the lesions on the face began to spread and further lesions appeared on both legs and on the right wrist. Irradiation and local applications were continued for a further three years, after which the patient stopped attending for hydnocarpate, and applications of carbon-dioxide snow. Full details are not available, but according to the patient the applications of snow were given daily for a short time and then at weekly intervals for several years. The condition showed little sign of improvement ; the patient, discouraged, again ceased attending hospital and came under the care of an outside doctor who scarified the lesions and prescribed various ointments. Two years ago, at the age of 47, the dressings on the patient's face accidentally caught fire; the resulting burn led to considerable scarring of the cheeks and an ectropion of the right eyelid. The lupus was not very active at this time, but a year ago the lesions all over the body flared up ; that on the chest, in particular, became very active and the right nipple was gradually eroded.The patient was first seen in the surgical out-patient department in July, 1952. She was then complaining mainly of the chest lesion and of a painful swell...