Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

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.

A new combination treatment for lupus vulgaris

A new method of combined treatment for lupus vulgaris is offered by Demuth (Dermal. Ztschr. Bd. 56, H. 2/3, 29), which he tested on "large material" and which consists in the fact that the patient is lubricated from the outside with the composition: ac. pyrogall., resorcini albi, ac. salicyl aa 7.0, talci ven., gelanthi Unna aa 5.0, and in addition, intravenous infusions of sulfates (Godyl, Plospanine) at a dose of 5 kb are used. see 2% solution daily. The author points out that the ointment treatment works quite vigorously in small lesions, but in large lesions, the proposed combination is recommended, the action of which is based on the fact that the pyrogall ointment is better tolerated, the convalescent tissue granulates more intensively and, finally, relapses are very rare.

Ulcerative Lupus Vulgaris on the Wrist

We report a case of ulcerative lupus vulgaris (LV) in a unique site, which facilitated the detection of internal organ tuberculosis (TB). A 68-year-old Japanese man presented with a reddish ulcerated painless lesion on his right wrist that had initially appeared 4 weeks earlier as a nontender nodule. There was no recent history of fever, weight loss, or cough. The results of tissue culture, PCR, and contrast-enhanced chest computed tomography were consistent with the diagnosis of ulcerative LV with underlying pulmonary TB and tuberculous lymphadenitis. The patient was started on anti-TB therapy. After 1 month of therapy, epithelialization of the ulcer was noted.

Disseminated Cutaneous Tuberculosis like Fungal Sporotrichosis Successfully Treated With Terbinafine: A Rare Case Report

Occurrence of Sporotrichosis is uncommon in Nepal. Here, we describe a case of cutaneous Sporotrichosis of 43 years old adult male working as a farmer from Pokhara-30, Nepal with unusual skin tuberculosis like presentation since 3 years, initiating from the unusual location in right pinna. Histopathological observation was suggestive of cutaneous tuberculosis, lupus vulgaris, cutaneous leishmaniasis due to overlapping findings during biopsy. The case was diagnosed by the pharma­cological intervention observing the effect of drugs i.e., terbinafine. The purpose of reporting this serendipitous case is to enhance timely diagnosis, avoid the diagnostic dilemma for future references.

A rare case of scrofuloderma along with lupus vulgaris

Cutaneous forms of tuberculosis (TB) are rare, comprising about 1-1.5% of all cases, and show a wide range of clinical manifestations. Here we present a case of a patient with left cervical ulcerated lymphadenopathy associated with a violaceous plaque in the area of the manubrium of sternum. We performed a biopsy of the plaque for histopathology, a polymerase chain reaction (PCR) to test for mycobacteria and a smear of the ulcerated lymph node. Histopathology results showed a dermal infiltrate consisting of epithelioid granulomas without necrosis, PCR was negative and the culture was positive for M. tuberculosis. We made the diagnosis of scrofuloderma associated with lupus vulgaris. The patient was treated with an anti-tuberculous therapy with clinical regression of the lesions. Our case emphasizes the importance of recognizing that tuberculosis can occur as a primary cutaneous pathology, with a challenging diagnosis that requires the correlation of clinical findings with diagnostic testing.