Lupus vulgaris on keloid
Department of Dermatology and Venereology, VSS Medical College, Burla, Sambalpur- 768 017, Orrisa
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Jena S, Mishra S S. Lupus vulgaris on keloid. Indian J Dermatol Venereol Leprol 2002;68:147-148
AbstractA 28-year-old man presented with multicentric lupus vulgaris on keloids over chest, axilla, neck and back for last 6 months. He had pulmonary tuberculosis. All the laboratory investigations were in favour of clinical diagnosis. The patient responded to antituberculosis therapy.
Cutaneous tuberculosis can present in different morphological forms. Though the incidence of cutaneous tuberculosis is on decline, it is still the major problem in India. In India lupus vulgaris is the commonest type of secondary tuberculosis of skin. Disseminate forms of lupus vulgaris are not uncommon. The lesions are usually solitary but two or more sites may be involved simultaneously and in patients with active pulmonary tuberculosis multiple foci may develop. The infection is exogenously acquired and hence the lesions usually appear on exposed, trauma prone areas. We are reporting a case of multifocal lupus vulgaris found over keloids associated with pulmonary tuberculosis.
A 28 - year -old man presented with multiple non-healing ulcers for last 6 months with loss of weight, fever and cough for last 2 months. The patient was having keloids over chest and back below left scapula since 5 years. For the last 6 months he developed ulceration over the keloid. The ulcer was progressive on one end and on the keloid. The ulcer was progressive on one end and on the other end there was scarring. Two months later he noticed two other plaque -like lesions over axilla which became ulcerated with peripheral spreading border and central atrophic scarring. He had taken some treatment but there was no improvement. His father was a known case of pulmonary tuberculosis. Examination revealed multiple ulcers on the keloids over chest and back below left scapula and as such over left axilla. The ulcers were serpinginous. Floor of the ulcer was thickly crusted at some places and at the other end of the ulcer there was scarring. Margin was raised, hypertrophic with few nodules over the margin. [Figure - 1]
As the patient was having fever, cough and weight loss he was referred to chest specialist for further examination and to exclude pulmonary tuberculosis.
Investigations revealed raised ESR. Mantoux reading was 24 mm and tuberculous granuloma was seen on histopathological study of the ulcer. X-ray chest showed cavities on right lung and bilateral hilar nodular shadows. Sputum for AFB was positive. Response to antituberculosis therapy i.e., INH rifampicin and ethambutol was excellent. Thus the case was confirmed to be a case of multicentric lupus vulgaris on keloid with pulmonary tuberculosis.
Cutaneous tuberculosis can present with unusual clinical and histopathological features causing delay in diagnosis. Sometimes there may be association with systemic tuberculosis as in our case.Thus thorough systemic examination in all cutaneous tuberculosis is necessary to exclude pulmonary tuberculosis. Multiplicity of the skin lesions and systemic involvement may be due to poor health and haematogenous dissemination.
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