Lupus vulgaris: Difficulties in diagnosis

Abstract

Lupus vulgaris is one of the most common forms of cutaneous tuberculosis. It presents a diagnostic challenge due to its paucibacillary nature. This is a report of a case of a delayed diagnosis of lupus vulgaris, presenting as perianal and peristomal plaques, followed by a review of the diagnostic tools for lupus vulgaris and their limitations.

Cutaneous tuberculosis overview and current treatment regimens

“…CTB is difficult to diagnose, due to its rare nature and the fact that it may present in various clinical forms [55,110,65]. Such clinical presentations can vary from small papules, warty lesions, ulcers, or papules to highly deformative plaques that are thickened and hyperkeratotic [24,37,49,63,8,53,35]. It is very important to diagnose and treat TB as early as possible to avoid any complications, although it has often been misdiagnosed as tinea corporis and carcinoma, for example [2,70,41,59,65].…”

“…Also, it involves chronic CTB in a previously sensitised patient with a high level of TB sensitivity. The most common form of this infection is lupus vulgaris, which also has the highest potential for disfigurement [21,62,25,63,43].…”

“…This form of LV starts as a flat, redbrown papule, which slowly expands into a light skin-coloured 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 plaque. It may show irregular areas of scarring and the edge of the plaque is often thickened and hyperkeratotic [66,63,8,53,67,35,68]. The ulcerative and mutilating form ( Figure 8) of LV is the most destructive and deforming of all LV lesions.…”

A case of tuberculosis verrucosa cutis in Brazil undiagnosed for 15 years

“…This clinical form manifests mostly in women, as latent nodules and annular plaques, or it may present with hypertrophic or vegetative lesions; lower extremities or buttocks are frequently affected areas. 6 Hematogenous metastatic tuberculous abscess occurs in immunocompromised patients that present single or multiple subcutaneous nodules, that can develop into ulcers or draining sinuses without regional adenopathy. This variant of cutaneous tuberculosis can appear as cellulitis or as purpuric papules that may become umbilicated and crusted.…”

“…Importantly, this type of lesion is unusual and frequently is associated with the activities of anatomists, physicians and bare-footed children living in tropical regions. 6 …”