Cutaneous tuberculosis (lupus vulgaris-type)

Lupus vulgaris is an extremely chronic, progressive form of cutaneous tuberculosis. The earliest description of lupus vulgaris was given by Erasmus Wilson in 1865. It usually occurs through contagious extension of the disease from underlying affected tissue or hematogenous or lymphatic spread. A 55 years male, non diabetic, non hypertensive, non smoker, got himself admitted into Dermatology and Venereology Department of DMCH with the complaints of multiple ulcerated lesions over the left lower thigh and upper leg including knee for 8 years. Histological sections of skin revealed multiple epithelioid granuloma, multinucleated giant cells and infiltration of lymphocytes with areas of fibrosis and ESR was 80 in 1st hour. The patient was treated with anti tubercular therapy and cured completely. DOI: http://dx.doi.org/10.3329/bmj.v41i2.18811 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 57-58

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Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

Our Dermatology Online ◽

10.7241/ourd.20221.12 ◽

2022 ◽

Vol 13 (1) ◽

pp. 53-56

Author(s):

Nouf Faihan Bin Rubaian ◽

Haya Fahad Alzamami ◽

Gadah Abdulatif Alhosawi ◽

Leena Abdulrahman Almuhaish

Keyword(s):

Delayed Diagnosis ◽

Punch Biopsy ◽

Lupus Vulgaris ◽

Cutaneous Tuberculosis ◽

Dorsal Aspect ◽

Skin Punch Biopsy ◽

Diagnostic Difficulties ◽

Anti Tubercular Therapy ◽

The Right ◽

Saudi Male

Lupus vulgaris (LV) is a progressive, chronic form of cutaneous tuberculosis (CTB). The head and neck regions are the most commonly affected sites, followed by the arms and legs. Occurring in unusual sites may pose diagnostic difficulties. Herein, we report a case of LV present on the dorsal aspect of the right hand in a twenty-year-old Saudi male. It was misdiagnosed as leishmaniasis as the patient lived in an area in which it was endemic, and was treated accordingly with no benefit. A skin punch biopsy was taken and the diagnosis of LV was confirmed. The lesion responded well to anti-tubercular therapy (ATT), yet healed with atrophic scarring. Although rare, clinicians must be aware of the importance of considering CTB as an important differential, as misdiagnosis or delayed diagnosis of this entity may eventually cause prolonged morbidity.

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Study of common clinical types of cutaneous tuberculosis: two years study experience in a tertiary care centre

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20200596 ◽

2020 ◽

Vol 6 (2) ◽

pp. 199

Author(s):

Raghu M. T. ◽

Ashwini S. ◽

Yogendra M. ◽

Virupakshappa H. E. ◽

Gangaraju Harish ◽

...

Keyword(s):

Tertiary Care ◽

Age Group ◽

Lupus Vulgaris ◽

Tertiary Care Centre ◽

Cutaneous Tuberculosis ◽

Medical College ◽

Plaque Type ◽

Study Experience ◽

The Common ◽

Work Up

Background: Cutaneous tuberculosis (TB) is frequently found worldwide, especially in tropical countries. The number of extrapulmonary TB reaches up to 14%, and 1% to 2% are cutaneous TB. Diagnosis of cutaneous tuberculosis (CTB) is complicated and requires a full work-up. Clinical manifestation of cutaneous TB is varied and causes difficulties to diagnose. Scrofuloderma and plaque type of lupus vulgaris (LV) are common forms of cutaneous TB.Methods: A retrospective study was conducted on patients attending Department of Dermatology, Venereology and Leprosy, at Basaveshwara Medical College and Hospital, Chitradurga over a period of 2 years. A total of 15 cases of cutaneous tuberculosis were diagnosed.Results: A total of 15 cases out of which included predominantly males, with age group being affected commonly are 20-40 decades, histopathology showing tuberculoid granuloma in 11 cases, and common clinical variant being lupus vulgaris seen in 66.6% of the cases and. Second common being scrufuloderma seen in 26.6% of the cases and least common is TB verrucosa cutis (TBVC) seen in 6.6% of the cases.Conclusions: The study showed that the common clinical type of cutaneous tuberculosis during the study period was lupus vulgaris, scrofuloderma and less common being TBVC.

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Borderline tuberculoid leprosy, lupus vulgaris and pulmonary tuberculosis: A rare association

Journal of Pathology of Nepal ◽

10.3126/jpn.v9i1.23382 ◽

2019 ◽

Vol 9 (1) ◽

pp. 1505-1507

Author(s):

Palzum Sherpa ◽

Amit Amatya ◽

Trishna Kakshapati

Keyword(s):

Pulmonary Tuberculosis ◽

Extrapulmonary Tuberculosis ◽

Granulomatous Inflammation ◽

Simultaneous Occurrence ◽

Lupus Vulgaris ◽

Posterior Aspect ◽

Mycobacterial Infections ◽

Cutaneous Tuberculosis ◽

First Case ◽

Tuberculoid Leprosy

Tuberculosis and leprosy are chronic mycobacterial infections that elicit granulomatous inflammation. The incidence of co-existence of pulmonary tuberculosis and leprosy has ranged from 2.5%-13.4%.1 Cutaneous tuberculosis is a variant of extrapulmonary tuberculosis and its simultaneous occurrence with leprosy is uncommon. The concomitant presence of leprosy, pulmonary as well as cutaneous tuberculosis is rare. We report a case of borderline tuberculoid leprosy, lupus vulgaris and pulmonary tuberculosis in a 45 years male who presented to the dermatology outpatient department with three morphologically distinct skin lesions over the posterior aspect of right leg. Ours is presumably the first case reported from Nepal, a country where both of these mycobacterial infections are endemic.

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Progressive asymptomatic annular facial skin lesions. Cutaneous tuberculosis (lupus vulgaris)

Archives of Dermatology ◽

10.1001/archderm.126.9.1227 ◽

1990 ◽

Vol 126 (9) ◽

pp. 1227-1227 ◽

Cited By ~ 2

Author(s):

W. P. Werschler

Keyword(s):

Skin Lesions ◽

Facial Skin ◽

Lupus Vulgaris ◽

Cutaneous Tuberculosis

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Lupus Vulgaris Occurring in a Locus Minoris Resistentiae

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2009.09005 ◽

2009 ◽

Vol 13 (6) ◽

pp. 313-316

Author(s):

Richard Long ◽

Anita Beatch ◽

Mao-Cheng Lee ◽

Melody Cheung-Lee ◽

Norman Wasel

Keyword(s):

Mycobacterium Tuberculosis ◽

Laboratory Tests ◽

Response To Treatment ◽

Lupus Vulgaris ◽

Cutaneous Tuberculosis ◽

Topical Corticosteroids ◽

Increased Temperature ◽

Local Trauma ◽

A Site

Background: The pathogenesis of lupus vulgaris, a form of cutaneous tuberculosis, is not always clear, especially in patients who do not have coexistent extracutaneous tuberculosis and in patients with single lesions. Objectives: To report a case of lupus vulgaris in a locus minoris resistentiae (a site of reduced resistance) and to use a unique set of clinical circumstances and laboratory tests to reconstruct the pathogenesis of the lesion and the response to treatment. Conclusion: Lupus vulgaris can occur in a locus minoris resistentiae; local trauma and possibly other factors, such as increased temperature, topical corticosteroids, and the virulence of the infecting strain, may facilitate the growth of Mycobacterium tuberculosis present at a locus minoris resistentiae as a result of a silent bacillemia.

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Clinicohistological Profile of Cutaneous Tuberculosis in Central Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v12i4.13727 ◽

2015 ◽

Vol 12 (4) ◽

pp. 238-241 ◽

Cited By ~ 2

Author(s):

M Mathur ◽

SN Pandey

Keyword(s):

Giant Cells ◽

Medical Sciences ◽

Lupus Vulgaris ◽

Internal Organs ◽

Female Ratio ◽

Cutaneous Tuberculosis ◽

The Past ◽

Central Nepal ◽

Type Giant ◽

Male To Female

Background There are few studies on cutaneous tuberculosis in Nepal.Objective To analyse the epidemiological, clinical and histological patterns of cutaneous TB over the past 5 years.Method Patients with cutaneous tuberculosis diagnosed from January 2010 to December 2014 at College of Medical Sciences, Chitwan, Nepal were included in the study. Chest radiography, routine investigations and screening for HIV was performed in all cases.Result A total of 47 clinical cases of cutaneous tuberculosis were diagnosed. The most commonly affected age group was 41-50 years. Male to female ratio was 1.5:1. Duration of cutaneous tuberculosis ranged from 1 month to 33 years. Lupus vulgaris was the most common clinical type (64%), followed by tuberculosis verrucosa cutis (19%). Two cases (4%) were diagnosed as papulonecrotic tuberculid. Overall, the most common site of involvement was extremities (55%) followed by head and neck, trunk, and perianal region. Histopathologic features of epitheloid cell granuloma with Langhans type giant cells were seen in 89% of cases, and in remaining 11% cases, chronic inflammatory dermatitis and nonspecific chronic dermatitis were observed.Conclusion M Tuberculosis is endemic in Nepal and the incidence of cutaneous tuberculosis at our centre was 0.1%. Lupus vulgaris was the most common type followed by tuberculosis verrucosa cutis in our study. Cutaneous tuberculosis can be accompanied by tuberculosis in internal organs and hence should be looked for. Clinicopathologic correlation is necessary to make a proper diagnosis.Kathmandu University Medical Journal Vol.12(4) 2014; 238-241

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LUPUS VULGARIS DENGAN LESI DISEMINATA

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.7.3.2015.9490 ◽

2015 ◽

Vol 7 (3) ◽

Author(s):

Nana N. Jayadi ◽

Niken Ernaningtyas ◽

Nurdjannah J. Niode ◽

Marthen C. P. Wongkar

Keyword(s):

Wound Care ◽

Giant Cells ◽

Lupus Vulgaris ◽

Open Wound ◽

Cutaneous Tuberculosis ◽

Left Neck ◽

The Face ◽

Night Sweats ◽

History Of ◽

Erythematous Plaques

Abstract: Lupus vulgaris (LV) is a chronic progressive form of paucibacillary cutaneous tuberculosis. Lesion is usually solitary in the form of nodes or erythematous plaques with an apple-jelly sign on diascopy. Disseminated LV is a rare form of cutanoeus tuberculosis with multiple lesions in several body areas. We reported a male of 40 years old with a suppurative wound on the left neck and reddish nodules on the face, neck, trunk, and limbs along with fever, night sweats, weight loss, and history of previous TB infections. There were multiple erythematous nodules and painful suppurating ulcers with enlargement of several lymph nodes. Apple-jelly sign appeared on diascopy. The FNAB showed specific granulamatous inflammation for TB with lymphocytes, epitheloid macrophages, and multinucleated giant cells. The histopathological finding showed tubercles surrounded by macrophages and lymphocytes. Anti-tuberculosis drugs category I were given for 6 months, ofloxacin, and open wound care compressed with NaCl 0.9%. In the third month of observation, there was significant improvement. Conclusion: This case was diagnosed as lupus vulgaris based on the history of lymphadenitis TB and scrofuloderma, lesions in several body area with positive diascopy test, the FNAB as well as the histopathologic result supporting the diagnosis of tuberculosis, and there was significant improvement after treatment with antiTB drugs.Keywords: lupus vulgaris, diseminata, tuberculosis, ofloksasinAbstrak: Lupus vulgaris (LV) merupakan tuberkulosis (TB) kutis pausibasiler kronis dan progresif. Lesi biasanya soliter, berupa nodus atau plak eritematosa dengan gambaran apple-jelly pada diaskopi. Lupus vulgaris diseminata merupakan bentuk TB kutis yang jarang ditemukan dengan lesi multipel pada beberapa area tubuh secara bersamaan. Kami melaporkan seorang laki-laki, 40 tahun, dengan luka bernanah pada leher kiri dan benjolan-benjolan kemerahan pada wajah, leher, badan, dan tungkai disertai demam, keringat malam, penurunan berat badan dan riwayat infeksi tuberkulosis sebelumnya. Pada pemeriksaan fisik tampak nodus eritematosa multipel disertai ulkus bernanah dan pembesaran beberapa kelenjar getah bening. Gambaran apple-jelly tampak pada diaskopi. Pemeriksaan FNAB menunjukkan gambaran radang granulomatik spesifik TB dengan adanya sel-sel radang limfosit, kelompok makrofag epiteloid, dan sel-sel datia Langhans. Pemeriksaan histopatologis memberikan gambaran tuberkel yang dikelilingi oleh makrofag dan limfosit. Terapi diberikan berupa OAT kategori I selama 6 bulan, ofloksasin, dan kompres terbuka dengan NaCL 0,9%. Pada bulan ketiga tampak perbaikan signifikan. Simpulan: Pada kasus ini, diagnosis lupus vulgaris ditegakkan berdasarkan adanya riwayat limfadenitis TB dan skrofuloderma, lesi di beberapa area tubuh sekaligus dengan pemeriksaan diaskopi positif, gambaran FNAB dan histopatologis menunjang diagnosis TB, dan pengobatan dengan OAT memberikan perbaikan bermakna.Kata kunci: lupus vulgaris, diseminata, OAT, ofloksasin

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