Sweat gland adenocarcinoma is a rare tumor particularly over scalp. They have potential to be benign as well as distant metastasis. Usually presents with papules or nodules. Ulcerative morphology is uncommon. Wide surigical excision with regional lymph not dissection is the treatment of choice. A 42-year-old female with sweat gland adenocarcinoma of scalp is reported with cervical lymph node involvement.

A 20-year-old female presented with non tender, fluctuant, soft swelling of left elbow, inability to flex elbows fully, plaques over both arms. On examination, there were 6 well defined erythematous scaly plaques, around 4-6 cm in diameter, involving both the arms. A single ulcer with purulent crust present over extensor aspect of left forearm. Atrophic scars were present over right elbow and right breast. Hyperpigmented puckered scar with multiple discharging sinuses were present over right forearm. There was no lymphadenopathy. On diascopy, "apple jelly" nodules were appreciated in form of yellowish discolouration after applying pressure with slide over the lesion. A fluctuant swelling of 8×11 cm size was present over extensor aspect of left arm along with swollen right elbow, due to which she was not able to flex her elbow completely [Table/ Fig-1]. Range of motion was 40 and 50 degree flexion at left and right elbow respectively. All lesions appeared in the span of 3 years. No past history of pulmonary TB. There was no history of trauma. She was vaccinated with BCG vaccine with a vaccine scar over her left deltoid. Her height was 137cm and weighed 42kg with significant undernourishment. She lives in overcrowded slum with poor hygienic conditions. Her aunt was suffering from pulmonary tuberculosis. Lupus vulgaris and scrofuloderma were suspected in the same case as erythematous plaques and puckered scar with sinus formation were there.Mantoux test was positive (>15mm induration and 22mm horizontal extension). Pus discharge from the ulcer was negative for grams and AFB stain didn't show any growth on routine culture. ELISA for HIV was nonreactive. Biopsy was taken from the erythematous plaque as well as puckered scar which showed mild hyperplasia of epidermis with multiple granulomas in dermis containing Langhans giant cells, epitheloid cells, lymphocytes and plasma cells suggestive of lupus vulgaris at both the sites. Reticular dermis was normal. No caseation necrosis was seen in both biopsies [Table /Fig-2 aBstRaCtMost common form of cutaneous tuberculosis (TB) is lupus vulgaris, which usually occurs in previously sensitized individuals who have a high degree of tuberculin sensitivity. Various forms including plaque, ulcerative, hypertrophic, vegetative, papular, and nodular forms have been described. We are reporting a case of a young female, who presented with 6 well defined erythematous scaly plaques involving both arms and a puckered scar on right forearm and right breast. Clinically, it was looking like lupus vulgaris with cold abscess, few lesions mimicking scrofuloderma, but skin biopsy from both the types of lesions revealed lupus vulgaris. Patient improved with Anti Tuberculous Therapy and surgical drainage of underlying cold abscess.[