Ulcerative lupus vulgaris over nose, leading to cosmetic deformity

Abstract

Lupus vulgaris (LV), is a chronic and progressive form of secondary cutaneous tuberculosis. In India, it is commonly seen over buttocks, thighs, and legs whereas involvement of nose is quite rare. Ulcerative variant particularly over nose causes destruction of cartilage, leading to irreversible deformities and contracture. High-index of suspicion is required for early diagnosis and prevention of cosmetic deformity. A case of LV over nose in a young male with ulceration is reported who responded well to anti-tubercular therapy, but left with scarring of nose, which could have been prevented if adequate awareness regarding extra-pulmonary cases would have been practiced.

Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

“…According to the World Health Organization (WHO), TB is considered the ninth leading cause of death worldwide [2]. Developing countries have the greatest burden of the disease, accounting for more than 90% of cases [4]. In Saudi Arabia, Riyadh and Dammam have the highest prevalence of Mycobacterium tuberculosis, with 22% and 21%, respectively, while the prevalence is the lowest in Jazan and Hail, with an incidence of 2% and 3%, respectively [5].…”

“…Tubercular infections vary from pulmonary to extrapulmonary. Only 1.5% of extrapulmonary cases of TB show cutaneous involvement [4]. The source of cutaneous a TB infection may be exogenous, endogenous, or following a BCG vaccination [6].…”

“…LV tends to spread contagiously or via hematogenous or lymphatic spread. It may affect individuals who have received Bacillus Calmette-Gué rin (BCG) inoculation or who have a positive delayed-type hypersensitivity reaction to tuberculin due to intact cell-mediated immunity [4]. There are five types of LV: Plaque, hypertrophic or vegetating, tumor-like, papular and nodular, and lastly the ulcerative type, which is known to be the most deformative type of LV [2].…”

Ulcerative lupus vulgaris primarily involving the ear lobule

“…[1] In India, the common sites of involvement are buttocks, thighs, and legs, whereas in the European population, the head and neck are most commonly involved. [4] In a study done in India, ulcerative type of LV was the least common (14.2%). [5] Case reports of LV affecting the face indicate that the cheeks and nose are the most frequently affected sites.…”

A case of multifocal tuberculosis involving skin and bone: An uncommon presentation

“…There are many conditions that mimic lupus vulgaris on the nose, which include lupus pernio (sarcoidosis), tuberculoid leprosy, lupoid leishmaniasis, Wegner's granulomatosis, Bowen's disease, deep fungal infection, lymphoma, necrobiotic xanthogranuloma, and psoriasis. [ 7 ]…”