Lupus Vulgaris Plaque Type on the Face Without Pulmonary Involvement: A Rare Case

Abstract

Cutaneous tuberculosis is a rare finding with a difficult diagnosis. This is mainly due to the low sensitivity and specificity of almost all diagnostic tests, accompanied by ambiguity in clinical presentations and non-specific clinical features. A 25-year-old Indian male is presented who reported having a thick, scaly lesion on the left side of his face. A definite diagnosis was achieved after a detailed clinical examination and a detailed diagnostic workup that involved a biopsy. He was put on antituberculous chemotherapy for six months.

Clinical Drug-Resistant Cutaneous Tuberculosis Presenting as Lupus Vulgaris Ulcerative Type in an Indian Female With Poncet’s Disease: A First-of-Its-Type Report

“…A positive polymerase chain reaction, tissue culture, or guinea pig inoculation result is the only way to positively identify Mycobacterium tuberculosis [6,7]. But it's a difficult task since cutaneous tuberculosis has paucibacillary features [4]. Additional relative criteria that are available include a thorough history and evaluation of lesions, the presence of acid-fast bacillus on lesions, the detection of active tuberculosis in other organs, the finding of a tuberculous granuloma on histopathological examination, a positive tuberculin test, and responsiveness to antituberculous drugs [7].…”

“…Lupus vulgaris, named for its ulcerating nature, is a rare, chronic form of tuberculosis. It typically spreads internally through the bloodstream or lymphatic system, occasionally through external sources like infected droplets [4]. Those sensitized to Mycobacterium tuberculosis often develop this form of cutaneous tuberculosis [7].…”

“…Cutaneous tuberculosis is an uncommon form of tuberculosis, with 5.9 incidents reported for every 1,000 people. The overall prevalence of cutaneous tuberculosis is 0.25-0.6%, based on multiple Indian studies [4]. It may be brought on by Mycobacterium bovis, the Mycobacterium tuberculosis complex, or, in rare cases, the Bacillus Calmette-Guérin vaccine [5].…”

“…It may be brought on by Mycobacterium bovis, the Mycobacterium tuberculosis complex, or, in rare cases, the Bacillus Calmette-Guérin vaccine [5]. It can show up clinically in a variety of ways, depending on the immune system of the individual, the environment, and the type of exposure [4]. In India, the most frequent form of skin tuberculosis in adults is lupus vulgaris (75%), but in children, scrofuloderma is more common.…”

“…In India, the most frequent form of skin tuberculosis in adults is lupus vulgaris (75%), but in children, scrofuloderma is more common. People with either a moderate or high level of immunity can be affected by lupus vulgaris, a paucibacillary, chronic, progressive, post-primary type of cutaneous tuberculosis [4].…”