Facial lupus vulgaris of bilateral periorbital skin and conjunctiva: A case report and brief review

Abstract

A 22-year-old male presented to the Dermatology Department with bilateral plaque lesions distributed symmetrically over malar area, bridge of nose and upper eyelids progressing over 1 year 3 months. Lesion remained unhealed after antibiotic treatment. Microscopy and culture for fungal and mycobacterial infections were negative. The Mantoux test showed an exaggerated response and PCR was positive for Mycobacterium tuberculosis complex. Patient was treated successfully with anti-tubercular therapy.

A Clinico-Mycological Study on Suspected Cases of Chromoblastomycosis: Challenges in Diagnosis and Management

“…Two cases, both presented with facial lesions were diagnosed as lupus vulgaris and responded well to anti-tubercular therapy. A similar case has been reported from Himachal Pradesh that showed bilaterally symmetrical non-healing facial lesion, initially suspected as chromoblastomycosis has been diagnosed as lupus vulgaris and confirmed by TB-PCR [14]. Another two lesions of our study, one on the left leg and the other on the right foot were diagnosed as hypertrophic lichen planus.…”

Lupus Vulgaris: A Diagnostic Challenge

“…Some authors further define the infection according to the amount of bacilli found in skin lesions as paucibacillary or multibacillary, the latter being associated with more deficient degrees of immunity. 2,4,9 In lupus vulgaris, it is known that individuals have moderate to high degrees of cell-mediated immunity, with adequate immune activation and normal serum immunoglobulin levels. The number of bacilli in the skin is small, and they are not detected in special staining in histopathology or PCR and most will not be able to grow in culture.…”

“…The number of bacilli in the skin is small, and they are not detected in special staining in histopathology or PCR and most will not be able to grow in culture. 2,4 Lupus vulgaris is secondary to a pre-existing focus, especially in the joints, bones or lymph nodes, and lesions depend mainly on the hematogenous and lymphatic spread of the microorganism. 10 In rare cases, the disease may develop after inoculation or an exogenous source.…”

“…3 Although considered the most common subtype of cutaneous tuberculosis in studies conducted in Spain, China, Indian, Japan and Pakistan, it is known that lupus vulgaris is underestimated and its diagnosis can be neglected. 4,5 We present an immunocompetent patient with lupus vulgaris whose clinical and histopathological features were challenging in establishing the diagnosis.…”

Unrecognized lupus vulgaris, revealed by its treatment

“…Its favorite localization is the face, especially the nose and cheeks. It is almost single, rarely multiple [3,4]. The diagnosis of certainly of the LV remains difficult.…”