Cutaneous tuberculosis (TB) can be caused by M. tuberculosis, M. bovis, and the Bacillus Calmette–Guérin (BCG) vaccine. The disease has diverse clinical features that can follow immune-mediated processes or endogenous and exogenous spread of the microorganism. The exogenous spread is less common. Even though cutaneous TB comprises less than 1% of all TB cases, it is important to consider it when a clinical picture suggestive of it is found [1]. Exogenous inoculation develops after M. tuberculosis is directly inoculated into the skin of an individual susceptible to the infection. This results in tuberculosis verrucosa cutis (TVC), TB chancre, and in some cases lupus vulgaris (LV). Endogenous spread occurs in previously infected cases by means of contiguous extension, hematogenous dissemination or through lymphatic circulation or in old scars of scrofuloderma [2]. Hematogenous spread is observed in LV, acute miliary TB, papulonecrotic tuberculoid (PNT), and metastatic TB abscess (gummatous TB). A contiguous extension can be seen in orificial TB and scrofuloderma.

LV is the most common type of cutaneous TB and affects females 2 to 3 times more often than males. It is chronic and progressive.The lesions of LV are commonly found in the region of the head and neck [3] and are generally solitary, small, sharply defined, nodular, reddish brown, with a gelatinous consistency (apple jelly nodules). In western countries, these lesions usually appear on the head and neck while in tropical or subtropical regions they develop on lower extremities and the buttocks.

The existing clinical variations are as follows:

• Classic plaque
• Keratotic
• Hypertrophic
• Ulcerative
• Vegetating

The classic plaques begin as discrete red-brown papules. They coalesce and form soft and gelatinous (apple-jelly) plaques with central atrophy and elevated verrucas border.

Persistent lesions become ulcerated and damage the underlying structures leading to disfigurement and have an increased risk of malignant transformation.

• Foul Smelling Discharge

  There was a foul smelling discharging sinus over outer aspect of right elbow [Figure - 1]. A similar sinus was present over medial aspect of lower 1/3 of left leg. Multiple scar marks were seen on the sides of neck. [ijdvl.com]

  CASE REPORT A 73-year-old male patient consulted to our outpatient clinics with complaints of ever-increasing number of non-healing wounds with foul-smelling discharge. [ncbi.nlm.nih.gov]

• Intermittent Fever

  The patient had a history of intermittent fever for the past 3 years. There was no history of weight loss or any other systemic complaints. There was no previous history of TB in the patient or family. [ijmyco.org]

• Plethora

  CTB includes a morphological plethora with primary-inoculation TB, tuberculous chancre, scrofuloderma, TB periorificialis and acute military TB in the multibacillary spectrum. [ijmm.org]

• Cervical Lymphadenopathy

  General and systemic examinations findings were insignificant, except for bilateral cervical lymphadenopathy. The body mass index was 16.6 Kg/m 2. [smjonline.org]

  RDD, originally known as sinus histiocytosis with massive lymphadenopathy, is a benign histiocytic proliferative disorder characterized clinically by a massive, painless, often bilateral cervical lymphadenopathy accompanied by fever, neutrophilia, anemia [scielo.br]

  Discussion BCG immunization has some complications include: Local reaction such as axillary or cervical lymphadenopathy, local subcutaneous abscess and keloids, skin lesions distinct from the vaccination site such as TB chancre, lupus vulgaris, scrofuloderma [pedinfect.com]

  Bilateral cervical lymphadenopathy was present. The rest of the systemic findings and vitals were normal. Considering the possibilities of sporotrichosis, chromoblastomycosis, cutaneous leishmaniasis and CTB, a skin biopsy was taken. [ijmm.org]

• Inguinal Lymphadenopathy

  There were also multiple inguinal lymphadenopathies. On the diascopy test, “apple jelly” sign was negative. [ijmyco.org]

• Chronic Cough

  She gave history of loss of weight of about 10 kg over the past one year, however she denied history of fever or chronic cough. On clinical examination she was found to be emaciated, anaemic and her body weight was 38 kg. [ijdvl.com]

  He did not have symptoms of chronic cough, weight loss, fever or decreased appetite. The hematological and biochemical parameters were within normal limits. Serological status for HIV was non-reactive. Mantoux test was positive. [ijpmonline.org]

• Lesion of the Pinna

  Keywords: Lupus vulgaris, Pinna, Tuberculosis How to cite this article: Gogia S, Agarwal A. Solitary lupus vulgaris of pinna: A rare presentation. [indianjotol.org]

• Skin Disease

  Skin and Connective Tissue Diseases Skin Diseases Skin Diseases, Infectious Skin Diseases, Bacterial Tuberculosis, Cutaneous Diseases Bacterial Infections and Mycoses Infection Skin Diseases, Infectious Skin Diseases, Bacterial Tuberculosis, Cutaneous [hon.ch]

  The term "lupus" to describe an ulcerative skin disease dates to the late thirteenth century, though it was not until the mid-nineteenth that two specific skin diseases were classified as Lupus erythematosus and Lupus vulgaris. [diki.pl]

  These findings are repetitively reported as suggestive for granulomatous skin diseases such as sarcoidosis, tuberculosis, and granuloma annulare. [hindawi.com]

  […] small lesions (usually in the lungs but in various other parts of the body in acute stages) lupus any of several forms of ulcerative skin disease [vocabulary.com]

• Cutaneous Manifestation

  Leprosy predominantly presents through skin manifestations whereas cutaneous manifestations of TB though not so frequent but are not rare. [ncbi.nlm.nih.gov]

  Cutaneous manifestations of secondary syphilis are protean and skin tuberculosis may be considered in the differential diagnosis, especially in HIV-infected patients. [moh-it.pure.elsevier.com]

• Skin Ulcer

  Skin biopsy from the edge of ulcer was also suggestive of tuberculosis. Patient is doing well on antituberculous drugs. [lungindia.com]

  If left untreated, the skin lesions can mature into skin ulcers. The term 'serpiginosus' means 'slow, snakelike' movement over the body, which leaves scarring. [wellcomecollection.org]

• Facial Skin Lesion

  Int J Dermatol 40: 336-339. [ Crossref ] Werschler WP, Elgart ML, Williams CM (1990) Progressive asymptomatic annular facial skin lesions. Cutaneous tuberculosis (lupus vulgaris). [oatext.com]

• Skin Plaque

  Generally, lupus vulgaris present as one or two plaques with or without involvement of systemic organs. Special feature in our case was alongwith multiple skin lesions, her joints, bones, lungs and lymph nodes were also affected. [ijdvl.com]

• Malar Rash

  Malar Rash About half of people with lupus experience a characteristic red “malar” rash or color change that may appear across the cheeks and bridge of the nose in the shape of a butterfly. [lupusresearch.org]

  Some people with lupus have a red rash over their cheeks and the bridge of their nose -- called a "butterfly" or malar rash. Hair loss and mouth sores are also common. [webmd.com]

  Rashes: butterfly-shaped rash over the cheeks - referred to as malar rash red rash with raised round or oval patches - known as discoid rash rash on skin exposed to the sun Mouth sores: sores in the mouth or nose lasting from a few days to more than a [rheumatology.org]

  Systemic lupus erythematosus Share on Pinterest A malar rash is a key symptom of lupus. Image credit: Doktorinternet, 2013. SLE is the most familiar type of lupus. It is a systemic condition. This means it has an impact throughout the body. [medicalnewstoday.com]

  rash (malar discoid rash not counted), bullous lupus, toxic epidermal necrolysis variant of SLE, maculopapular lupus rash, photosensitive lupus rash (in the absence of dermatomyositis) or Subacute cutaneous lupus (nonindurated psoriaform and/or annular [merckmanuals.com]

• Facial Ulceration

  This delay could have been averted if there was a high index of clinical suspicion especially with her unexplained and progressive ulcerated and nodular facial lesions. [ispub.com]

The diagnosis of LV can be a challenging task as the skin changes are atypical and there is a paucity of TB bacilli in the lesions.

Skin biopsy and histology may show tubercules or tuberculoid granulomas without caseation in the papillary dermis with few or no bacilli, and variable epidermal hyperplasia [4] [5]. If a superficial biopsy is obtained then pseudo-epithelial hyperplasia with a non-specific inflammatory cell infiltrate may be observed, missing the features of LV [6].

Identification of Mycobacteria is essential for the definitive diagnosis of cutaneous TB but this is usually impossible since there are few bacilli. M. tuberculosis rarely grows on culture when the sample is taken from a patient with high levels of immunity or from chronic lesions.

Special tests like the polymerase chain reaction (PCR) can be performed to confirm the diagnosis or when the histopathological findings are not characteristic of the condition [7].

Ziehl-Neelsen staining and PCR may also give negative results in LV due to the paucity of TB bacilli [8] [9].

Diagnosis relies heavily on clinical features, histopathological findings, a positive purified protein derivative test (PPD) and response to anti-TB medication [2] [10].

The differential diagnosis of cutaneous TB includes leprosy, leishmaniasis, syphilis, actinomycosis, and deep mycosis.

• Skin Test Positive

  In addition, men are more likely than women to have a positive tuberculin skin test result. The reason for these differences may be social, rather than biologic, in nature. [emedicine.com]

• Abnormal Renal Function

  Chest, cardiovascular system and abdominal examination revealed no abnormality. Renal function test and liver function test were found to be normal. [ijpmonline.org]

• Mycobacterium Fortuitum

  We report a woman with a lupus vulgaris-like skin eruption caused by Mycobacterium fortuitum. [ncbi.nlm.nih.gov]

  Mycobacterium chelonae illnesses associated with tattoo ink. N Engl J Med. 2012;367:2357. Philips RC, Hunter‑Ellul LA, Martin JE, Wilkerson MG. Mycobacterium fortuitum infection arising in a new tattoo. Dermatol Online J. 2014;15:20. [ijord.com]

• Granulomatous Tissue

  CLINICAL FEATURES The skin covering the inflamed lymph nodes becomes indurated, purplish in color followed by ulceration with crusty ,irregular pale granulomatous tissue ending in scarring. [drmhijazy.com]

A diagnosis of lupus vulgaris was made based on histopathology, culture and polymerase chain reaction, and isoniazid, rifampicin and ethambutol were administered as antituberculosis treatment. [ncbi.nlm.nih.gov]

IVb and IVc and noted that 695 (94%) of the remaining 737 cases were responding favourably to treatment. [jameslindlibrary.org]

It is the most common type of cutaneous tuberculosis.Lupus Vulgaris: Read more about Symptoms, Diagnosis, Treatment, Complications, Causes and Prognosis. [nsxmj.co]

New search Scientific articles from MEDLINE for "Lupus Vulgaris" - English - French - German - Spanish - Portuguese - Italian All recent articles Therapy: by recall / by precision Diagnosis: by recall / by precision Etiology: by recall / by precision Prognosis [hon.ch]

Deep fungal infection[4] Management[edit] A dermatologist or general physician usually administers combination therapy of drugs used for tuberculosis, such as Rifampicin, Isoniazid and Pyrazinamide (possibly with either streptomycin or ethambutol).[3] Prognosis [en.wikipedia.org]

The etiology and pathology of many diseases have been cleared up and the way leading to the elucidation of many mooted questions pointed out. [jamanetwork.com]

Consult HON's world-wide database of medical meetings Browse - New search Refine the search for "Lupus Vulgaris" Subheadings: complications / diagnosis / embryology / epidemiology / etiology / metabolism / microbiology / surgery / therapy Broader term [hon.ch]

Lupus vulgaris is also known as tuberculosis luposa cutis or tuberculosis cutis luposa because of its etiologic agent. [wisegeek.com]

Etiology Etiology is still elusive but it is thought to be multifactorial, involving a genetic predisposition. [orpha.net]

BACKGROUND: The epidemiological aspects and diagnostic problems encountered in a rural set up are largely unknown. [ncbi.nlm.nih.gov]

Consult HON's world-wide database of medical meetings Browse - New search Refine the search for "Lupus Vulgaris" Subheadings: complications / diagnosis / embryology / epidemiology / etiology / metabolism / microbiology / surgery / therapy Broader term [hon.ch]

History and epidemiology of tattoos and piercings. Legislation in the United States. In: Dermatologic Complications with Body Art. 2009: 1–11. Goldstein N. Tattoos defined. Clin Dermatol. 2007;25(4):417–20. Sanghavi SA, Dongre AM, Khopkar US. [ijord.com]

Leprosy and tuberculosis: The epidemiological consequences of cross-immunity. [dx.doi.org]

[…] develops due to inadequately treated pre-existing tuberculosis.[3] It may also develop at site of BCG vaccination.[4] Rarely, it has been shown to be associated with tattoo mark and also with long term bindi use, the so-called "bindi tuberculosis".[5][6] Pathophysiology [en.wikipedia.org]

The term "lupus" may derive from the rapacity and virulence of the disease; a 1590 work described it as "a malignant ulcer quickly consuming the neather parts; ... very hungry like unto a woolfe".[3] Pathophysiology Lupus vulgaris often develops due to [wikidoc.org]

Early diagnosis and treatment of lupus vulgaris might have prevented the development of carcinoma in lupo and ensuing metastatic death of the patient. [ncbi.nlm.nih.gov]

Treatment of specific manifestations of SLE is aimed at prevention of complications. [medical-dictionary.thefreedictionary.com]

1. Rai VM, Shenoi SD, Gowrinath K. Tuberculous gluteal abscess coexisting with scrofuloderma and tubercular lymphadenitis. Dermatol Online J. 2005;11(3):14.
2. Marcoval J, Servitje O, Moreno A, et al. Lupus vulgaris. Clinical, histopathologic, and bacteriologic study of 10 cases. J Am Acad Dermatol. 1992;26(3 Pt 2):404–407.
3. Barbagallo J, Tager P, Ingleton R, Hirsch RJ, Weinberg JM. Cutaneous tuberculosis: diagnosis and treatment. Am J Clin Dermatol 2002;3(5):319-328.
4. Farina MC, Gegundez MI, Pique E, et al. Cutaneous tuberculosis: a clinical, histopathologic, and bacteriologic study. J Am Acad Dermatol. 1995;33:433–440.
5. Tan SH, Tan BH, Goh CL, et al. Detection of Mycobacterium tuberculosis DNA using polymerase chain reaction in cutaneous tuberculosis and tuberculids. Int J Dermatol. 1999;38:122–127.
6. Andrew PW, Edward WJ. Cutaneous tuberculosis of the nose with unusual clinical and histological features leading to a delay in the diagnosis. Clin exp Dermatol. 1977;2:235-242.
7. Khandpur S, Reddy BS. Lupus vulgaris: Unusual presentations over the face. J Eur Acad Dermatol Venereol. 2003;17:706-710.
8. Sehgal V. Cutaneous tuberculosis. Dermatol Clin. 1994;12:645–53.
9. Aliağaoğlu C, Atasoy M, Güleç AI. Lupus vulgaris: 30 years of experience from eastern Turkey. Clin Exp Dermatol. 2009;34:e289.
10. İnönü H, Sezer E, Doruk S, Koseoglu D. Cutaneous tuberculosis: report of three lupus vulgaris cases: original image. Turkiye Klinikleri J Med Sci. 2009;29:788–91.