Therapierefraktäre „Psoriasis vulgaris“

Abstract

A 61-year-old patient had a 25-year history of erythematous scaling lesions, diagnosed and treated as psoriasis vulgaris. He presented with a growing nodule within the erythematous plaque. Biopsy shows epithelioid cell granulomas with prominent Langhans giant cells. There was no sign of a squamous cell carcinoma. The tuberculin test was strongly positive and M. tuberculosis complex was detected in the biopsy material by PCR. He was diagnosed with lupus vulgaris, the most frequent form of cutaneous tuberculosis. Other types include tuberculosis verrucosa cutis, tuberculosis cutis orificialis and disseminated military tuberculosis. The patient was treated with rifampicin, isoniazid, pyrazinamide and ethambutol for two months, following a four month treatment with rifampicin and isoniazid. The skin lesions rapidly resolved under antituberculotic treatment.

Lupus vulgaris masquerading as tumorous growth

“…1 However, lupus vulgaris presenting as tumor-like and bulbous lesions is rare. [2][3][4][5][6][7][8] [Table 1] In all the previously reported cases, tumor-like lesions were studded over the plaques of lupus vulgaris lesions, whereas in the present case, swelling and distortion of the toes had resulted in a nodular and bulbous look; which is evident from the presence of nail in each tumor-like growth and X-ray showing distorted phalanges and the toe bones.…”

“…1 Tumor-like and bulbous lesions have been described rarely in the literature. [2][3][4][5][6][7][8] We report a case of lupus vulgaris which had resulted in tumorous transformation and distortion of the toes, causing confusion and delay in diagnosis and treatment leading to chronicity of the lesion and deformity.…”