Mycobacterium aviuminfection of the skin associated with lichen scrofulosorum: report of three cases

Abstract

We report three Japanese children with Mycobacterium avium infection of the skin who also developed lichen scrofulosorum, a previously undescribed association. They were healthy except for the presence of several noduloulcerative lesions associated with multiple asymptomatic papules on the trunk and extremities. Histology of the ulcerative lesions showed features of mixed-cell granuloma, whereas the papular lesions showed features consistent with lichen scrofulosorum. M. avium was identified by polymerase chain reaction-aided DNA-DNA hybridization analysis in specimens obtained from the noduloulcerative lesions. Both the noduloulcerative and the papular lesions responded well to combination chemotherapy consisting of antituberculous agents and antibiotics.

Mycobacterial spindle cell pseudotumor of the skin

“…The cutaneous lesions of MAI can occur following traumatic skin inoculation, extension from lymphadenitis, or dissemination from primary visceral lesions, in both immunocompetent and immunocompromised patients such as those with HIV infection 25 . There was no evidence to identify the infection route in our patient’s medical history and clinical examinations.…”

Lichen scrofulosorum: current status

“…The lesions are characteristically disposed over the trunk 4 . Unusual morphological variations in the form of nodulo‐ulcerative lesions associated with multiple asymptomatic nodules on the trunk and extremities following Mycobacterium avium infection have also been described 14 . Transformation of papulo‐necrotic tuberculid to LS is another interesting observation 15 .…”

Tuberculid in a child: transformation from papulonecrotic to lichen scrofulosorum

“…Phlyctenular conjunctivitis was present in 50% of patients in one series. Lichen scrofulosorum‐like lesions also have been seen following BCG vaccination and Mycobacterium avium infection of the skin (5,6).…”