Simultaneous Occurrence of Papulonecrotic Tuberculid and Erythema Induratum in a Patient with Pulmonary Tuberculosis

Abstract

Although papulonecrotic tuberculid is an uncommon cutaneous manifestation of tuberculosis (TB) associated with Mycobacterium tuberculosis infection, the simultaneous occurrence of papulonecrotic tuberculid and erythema induratum is even rarer. Papulonecrotic tuberculid occurs predominantly in young adults and is characterized by eruptions of necrotizing papules that heal with varioliform scars. Histopathologic findings include wedge-shaped necrosis of the dermis, poorly formed granulomatous infiltration, and vasculitis. Stainings and culture for acid-fast bacilli from skin biopsies are usually negative for M. tuberculosis, although the eruptions resolve with antitubercular therapy. Few patients with papulonecrotic tuberculid, especially with concurrent occurrence of erythema induratum, have been reported in the English literature. Here we report a case of a 12-year-old girl with simultaneous occurrence of papulonecrotic tuberculid and erythema induratum accompanying pulmonary TB.

Concomitant erythema induratum of Bazin and papulonecrotic tuberculid: A rare manifestation

“…Although no source of active infection was found this is not unusual. It has been suggested that the failure to detect mycobacteria is a result of rapid destruction of organisms in hypersensitive individuals [6]. The occurrence together of two tuberculids is extremely rare but when this has been reported previously the commonest combination appeared to be PTN and EI as seen in our patient [4].…”

Relato da ocorrência simultânea de escrofuloderma, eritema indurado de Bazin e tuberculide pápulo-necrótica em paciente imunocompetente

“…Estas consistiram de lesões clinicamente compatíveis com o eritema indurado de Bazin (EIB) nas panturrilhas e lesões disseminadas de tubercúlide pápulo-necrótica (TPN). Na literatura, existem 12 casos descritos da associação do EIB com a TPN ocorrendo simultaneamente, 6,7 no entanto não encontramos nenhum relato da ocorrência de três formas concomitantes, que explica a multiplicidade de lesões cutâneas com aspectos clínicos diferentes.…”

Cutaneous tuberculosis overview and current treatment regimens

“…All of the tuberculids show a positive response to anti-tuberculous therapy, though they are characterised by negative smears for AFB. Tuberculids may also occur as a result of BCG vaccination, and consequently the vaccination is now only recommended for certain high risk groups [21,72,73,37,25,74,8,35]. True tuberculids can be classified as follows:…”

“…Surgical excision of lesions and the correction of deformities can also be performed [66,25,44,107,20]. Since tuberculids are an allergic reaction to M. tuberculosis, present in the patient's system, anti-tuberculous therapy is also recommended for such lesions [62,74,35].…”