Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis

Abstract

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 10-year-old boy who was diagnosed as lupus vulgaris clinically and histopathologically. He had well demarcated, irregularly bordered, pink, infiltrated plaques on his left cheek showing apple-jelly appearance on diascopy. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux reactivity was in normal limits, and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed marked improvement on anti-tuberculosis treatment. We want to emphasize that histopathological examination has diagnostic value in lupus vulgaris in correlation with clinical appearance, when direct analysis or culture is negative.

Cutaneous tuberculosis and squamous-cell carcinoma

“…Cutaneous tuberculosis is caused by Mycobacterium tuberculosis, Mycobacterium bovis, and under certain conditions, the bacillus CalmetteGuérin (BCG) 1,2 . Lupus vulgaris is a chronic and progressive form of secondary cutaneous tuberculosis that occurs in tuberculin-sensitive patients.…”

Bacillus Calmette-Guerin Vaccine-Induced Lupus Vulgaris in a Child With Trisomy 9

“…Lupus vulgaris is a rare skin complication of the BCG vaccine and is presented by reddish brown plaque with apple-jelly nodules occur usually on the face and neck. Skin biopsy shows accumulations of epithelioid histiocytes with Langerhans giant cells and varying amount of caseation necrosis in the center; however, the absence of caseation necrosis may not rule out the diagnosis of TB (5). Prevalence of LV is 1 per 100000 to 200000 vaccinations (3,6).…”

“…Diagnosis is usually confirmed by PCR, Tuberculin Skin Test (TST), histopathological results and response to therapy (8,12). Although tuberculoid granuloma formation is highly characteristic of cutaneous TB, it is not pathognomonic because histological pattern may be similar to fungal infection, syphilis, leprosy and clinical judgment can help to make the diagnosis (5). When the sample is smear negative, PCR sensitivity will decrease and the result may be negative (13,14).…”

Apple Jelly Nodule

“…1 Lupus vulgaris is the most common type of cutaneous tuberculosis. Lupus means wolf or the appearance of face as eaten by wolf.…”