Verrucous tuberculid mimicking Kyrle disease

Abstract

Cutaneous tuberculosis shows wide clinical variation depending upon the virulence of the organism and host immunity. Tuberculids are difficult to diagnose since the organism often cannot be identified or isolated by microscopy, culture or polymerase chain reaction. The diagnosis rests primarily on the identification of a tuberculous focus elsewhere in the body and response to antitubercular therapy. We present the clinicopathological features of an unusual tuberculid in a 30-year-old man, remarkably mimicking Kyrle's disease. He presented with multiple, symmetrically distributed follicular and perifollicular verrucous papules, nodules and plaques on the face, earlobes and extremities since 4 years. Histopathology revealed parakeratotic follicular plug invaginating into the dermis with multiple caseating epithelioid cell granulomas. PCR for M. tuberculosis was negative. The identification of associated axillary tubercular lymphadenitis, strongly positive Mantoux reaction, tuberculoid granulomas on histopathology and complete resolution of the lesions with antitubercular therapy helped in making the diagnosis. We propose the term "verrucous tuberculid" for this entity.

Co‐existence of atypical tuberculid with lupus vulgaris

“…LS mimicking various dermatoses including psoriasiform, eczematous, and pustular lesions have been highlighted earlier 9 . There have been few other isolated reports of atypical presentations of tuberculids including verrucous tuberculid, phlebitic tuberculids, and molluscum‐like papules in adult patients 12–15 . Whereas, lesions in our patient were progressive, scaly hypopigmented macules, and skin colored to hypopigmented scaly papules.…”

Molluscum-Like Papules as a Presentation of Early Papulonecrotic Tuberculid in Association with Nodular Tuberculid in a Male with Asymptomatic Active Pulmonary Tuberculosis

“…More recently described reports of tuberculids include nodular granulomatous phlebitis, in which nodules run along the course of a leg vein, 7 verrucous tuberculid, 8 and NT. 2…”

“…More recently described reports of tuberculids include nodular granulomatous phlebitis, in which nodules run along the course of a leg vein, 7 verrucous tuberculid, 8 and NT. 2 We document the first case of PNT showing the molluscum-like lesions and its rare association with NT.…”

Papulonecrotic tuberculid

“…9 Vesicular, pustular, lichenoid and umbilicated lesions, as well as verrucous variants resembling acquired perforating dermatosis, have been described. 13,14 Koebnerization of PNT lesions has been reported, 15 as has the appearance of PNT lesions at the tuberculin testing site on the arm. 16 In patients with HIV, PNT can occur after the initiation of antiretroviral therapy, due to the improvement in immunity.…”

“…Without treatment, spontaneous resolution of individual lesions can occur in a few weeks, with simultaneous occurrence of new lesions 9 . Vesicular, pustular, lichenoid and umbilicated lesions, as well as verrucous variants resembling acquired perforating dermatosis, have been described 13,14 . Koebnerization of PNT lesions has been reported, 15 as has the appearance of PNT lesions at the tuberculin testing site on the arm 16 .…”