• View in gallery
    Figure 1.

    (A) A 7.25 × 6.25-cm pear-shaped, well-defined erythematous scaly plaque with crusting and areas of atrophy and scarring. (B) Lesion resolved, with wrinkled atrophic scarring after treatment. This figure appears in color at www.ajtmh.org.

  • View in gallery
    Figure 2.

    Positive tuberculin test. This figure appears in color at www.ajtmh.org.

  • View in gallery
    Figure 3.

    (A) Hematoxylin–eosin staining and low-power view shows multiple well-formed epithelioid granulomas with or without giant cells surrounded by lymphocytic infiltrates in the dermis. (B) Hematoxylin–eosin staining and high-power view shows granuloma with giant cells and lymphoplasmacytic infiltrates. This figure appears in color at www.ajtmh.org.

  • 1.

    Khadka P, Koirala S, Thapaliya J, 2018. Cutaneous tuberculosis: clinicopathologic arrays and diagnostic challenges. Dermatol Res Pract 2018: 7201973.

    • Search Google Scholar
    • Export Citation
  • 2.

    Santos JB, Figueiredo AR, Ferraz CE, Oliveira MH, Silva PG, Medeiros VL, 2014. Cutaneous tuberculosis: diagnosis, histopathology and treatment—part II. An Bras Dermatol 89: 545555.

    • Search Google Scholar
    • Export Citation
  • 3.

    Singal A, Sonthalia S, 2010. Cutaneous tuberculosis in children: the Indian perspective. Indian J Dermatol Venereol Leprol 76: 494503.

    • Search Google Scholar
    • Export Citation
  • 4.

    Kumar B, Kumar S, 2018. Pediatric cutaneous tuberculosis: Indian scenario. Indian J Paediatr Dermatol 19: 202211.

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Lupus Vulgaris

Palaniappan VijayasankarDepartment of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India

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Raveendran PremjithDepartment of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India

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Kaliaperumal KarthikeyanDepartment of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India

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A 16-year-old Indian boy presented with an 8-year history of an asymptomatic, slowly progressive skin lesion over the left knee. Examination showed a single, well-defined erythematous scaly plaque with crusting, and areas of atrophy and scarring (Figure 1A). the general examination was normal. The patient’s past medical history and family history were not significant. A tuberculin skin test was strongly positive (Figure 2). Incisional biopsy revealed multiple well-formed epithelioid granulomas with or without giant cells surrounded by lymphocytic infiltrates in the dermis (Figure 3). Ziehl-Neelson staining of the tissue section, mycobacterial culture of a tissue specimen, and polymerase chain reaction for Mycobacterium tuberculosis were negative. Based on the clinicopathologic findings, a diagnosis of lupus vulgaris was made. The patient was treated with antituberculous therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol) for 6 months. At the end of treatment, the lesion had healed well, leaving an atrophic, wrinkled scar (Figure 1B).

Figure 1.
Figure 1.

(A) A 7.25 × 6.25-cm pear-shaped, well-defined erythematous scaly plaque with crusting and areas of atrophy and scarring. (B) Lesion resolved, with wrinkled atrophic scarring after treatment. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 105, 6; 10.4269/ajtmh.21-0736

Figure 2.
Figure 2.

Positive tuberculin test. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 105, 6; 10.4269/ajtmh.21-0736

Figure 3.
Figure 3.

(A) Hematoxylin–eosin staining and low-power view shows multiple well-formed epithelioid granulomas with or without giant cells surrounded by lymphocytic infiltrates in the dermis. (B) Hematoxylin–eosin staining and high-power view shows granuloma with giant cells and lymphoplasmacytic infiltrates. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 105, 6; 10.4269/ajtmh.21-0736

Lupus vulgaris is a chronic, progressive paucibacillary form of cutaneous tuberculosis. Criteria for diagnosis are variable. Tuberculin skin testing is usually positive.1 Analysis of a biopsy specimen should include histopathology, tissue smear, bacteriologic cultures, and polymerase chain reaction, but may be negative, as in this case of paucibacillary disease reminiscent of tuberculoid leprosy.2 Assessment for pulmonary and extrapulmonary tuberculosis should be done.3 Complications may occur, including secondary bacterial infections, mutilation, destruction, scarring, and joint contractures.3,4 Cutaneous tuberculosis generally responds well to antituberculous treatment.2

REFERENCES

  • 1.

    Khadka P, Koirala S, Thapaliya J, 2018. Cutaneous tuberculosis: clinicopathologic arrays and diagnostic challenges. Dermatol Res Pract 2018: 7201973.

    • Search Google Scholar
    • Export Citation
  • 2.

    Santos JB, Figueiredo AR, Ferraz CE, Oliveira MH, Silva PG, Medeiros VL, 2014. Cutaneous tuberculosis: diagnosis, histopathology and treatment—part II. An Bras Dermatol 89: 545555.

    • Search Google Scholar
    • Export Citation
  • 3.

    Singal A, Sonthalia S, 2010. Cutaneous tuberculosis in children: the Indian perspective. Indian J Dermatol Venereol Leprol 76: 494503.

    • Search Google Scholar
    • Export Citation
  • 4.

    Kumar B, Kumar S, 2018. Pediatric cutaneous tuberculosis: Indian scenario. Indian J Paediatr Dermatol 19: 202211.

Author Notes

*Address correspondence to Palaniappan Vijayasankar, No 72, Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical college and Hospital, Pondicherry, India 605107. E-mail: vijayasankarpalaniappan@gmail.com

Authors’ addresses: Palaniappan Vijayasankar, Raveendran Premjith, and Kaliaperumal Karthikeyan, Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry India, E-mails: vijayasankarpalaniappan@gmail.com, jithuls1990@gmail.com, and karthikderm@gmail.com.

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