Tuberculosis, still one of the most common infectious diseases globally, manifests primarily as pulmonary tuberculosis. Extra-pulmonary tuberculosis can occur in other sites including skin. Cutaneous tuberculosis, comprising merely 1-2% of all forms of tuberculosis, has been classified into various morphological variants. One of the morphological variants of cutaneous tuberculosis is erythema induratum, a tuberculid, which is caused by hematogenous spread of tuberculosis, the pathogenesis of which is due to hypersensitive reaction against the mycobacterial antigens. The skin biopsy findings of erythema induratum are characterized by panniculitis with formation of non-caseating epithelioid granulomas with no mycobacteria detected in the lesions, though mycobacterial antigens or DNA could be detected by polymerase chain reaction (PCR). In this context, being presented here is a case of erythema induratum which is rare and unusual in its presentation inasmuch as caseating epithelioid granulomas were seen in the lesional skin biopsy along with detection of acid-fast bacilli. In our study a 57-year-old male presented to the Dermatology OPD with multiple erythematous lesions bilaterally over the groin and thigh regions. Clinically the lesions were considered to be equivocally suggestive of migratory erythema or erythema marginatum. The skin biopsy taken from the lesions revealed multiple epithelioid granulomas in the dermis with central areas of caseation necrosis. Sections stained with Ziehl-Neelsen stain showed the presence of occasional acid-fast bacilli. Erythema induratum, a rare tuberculid form of cutaneous tuberculosis, which is pathogenetically considered to be occurring as a result of hypersensitivity reaction against mycobacterial antigens with characteristic absence of tubercle bacilli. In the case presented here erythema induratum presents in a rare unusual manner as a caseating granulomatous lesion with presence of demonstrable acid-fast bacilli.

Tuberculosis primarily affects lungs, though involvement of extra-pulmonary sites is on a relative rise in the backdrop of increased incidence of immune compromised disorders such as HIV/AIDS. The extra-pulmonary sites which are most commonly involved are lymph nodes, genitourinary tract, bone marrow, CNS and musculoskeletal system. Tuberculosis of musculoskeletal system includes bones, joint, bursas and tendons or tenosynovium, the incidence of which is rare. Though tuberculosis involves various parts of musculoskeletal system, involvement of wrist and hand is quite rare. Since the involvement of joints of wrists by tuberculosis is very uncommon. Early diagnosis of tuberculosis of wrist is often difficult, in as much as clinical manifestations of other arthritides mimic tuberculous tenosynovitis. Many times, operative findings of melon seed bodies are characteristically suggestive of tuberculosis. The case being presented here is unique and unusual one, which characteristically presented with intraoperative finding of numerous water melon seed which are considered in literature to be helpful in diagnosis of tuberculous arthritis.

The co-existence or concurrent occurrence of brain tumours having different histomorphological features, in the absence of neurofibromatosis central (NF2) or history of irradiation is very rare. Such co-existence of brain tumours with different histology are referred to as collision tumours, concomitant tumours or contiguous tumours. The patient had no history of Von Recklinghausen’s disease nor had any personal or family history of phacomatoses, but, however, he had history of undergoing near total resection of left-sided vestibular schwannoma one year backThe simultaneous occurrence of meningioma and schwannoma is highly uncommon in cerebellopontine angle with only few published cases of co-existing meningioma and schwannoma in patients with no history of neurofibromatosis or other such phacomatoses, albeit this phenomeno of co-existence of these tumours is associated with neurofibromatosis 2 or other phacomatoses. It is also proposed that reactive meningothelial hyperplasia adjacent to the main tumour could be responsible for the presence of meningothelial component within schwannoma