N. Paththinige1,2,3, C. Ariyarathna3, A. Wickramanayake3, P. Karunarathne3, C. Maddumaarachchi3, J. Akarawita3
Cutaneous tuberculosis (TB) is a rare presentation of extrapulmonary TB and most common variety of cutaneous TB is lupus vulgaris (LV). LV usually occurs in previously sensitised individuals who have a high degree of tuberculin sensitivity and has varying clinical presentations.
We report the clinical, therapeutic and outcome features of 10 cases of LV.
Six females and 4 males included aged 18–75 years. All were previously healthy. Eight patients had plaque type LV, 5 with lesions on the face and another 3 with leg lesions. Other two had hypertrophic type and papular type LV. Four patients presented within 1 year of appearance of the lesions and other 6 were delayed for more than 2 years. 9/10 did not have evidence of systemic involvement with TB.
All demonstrated tuberculoid type granulomas on skin histology with negative Ziehl Neelsen stain for acid fast bacilli. All had positive mantoux tests. TB culture of skin specimens was performed, yet all were negative. TB PCR was performed in 7 patients and 4 had positive results for mycobacterium tuberculosis.
All were started on anti tuberculous therapy with rifampicin, isoniazid, pyrazinamide and ethambutol for 6 months. Eight patients showed complete healing of lesions with some residual scarring and 2 needed extended treatment for another 3 months.
Conclusion: This case series highlights the importance of suspicion of LV in patients presenting with chronic skin lesions of varying morphology in countries endemic for TB.