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CASE REPORT
Year : 2015  |  Volume : 6  |  Issue : 2  |  Page : 120-121  

Sporotrichoid lupus vulgaris: A rare presentation


Department of Dermatology, Venereology and Leprology, SMS Medical College, Jaipur, Rajasthan, India

Date of Web Publication11-Mar-2015

Correspondence Address:
Puneet Bhargava
Department of Dermatology, D-60, Mahesh Marg, Bapu Nagar, Jaipur - 302 015, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.153017

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   Abstract 

Lupus vulgaris is the most common presentation of cutaneous tuberculosis in India and can present as papular, nodular, plaque, ulcerative, vegetating, and tumid forms. Unusual variants include the frambesiform, gangrenous, ulcerovegetating, lichen simplex chronicus, myxomatous, and sporotrichoid types. We describe a rare sporotrichoid presentation of lupus vulgaris on the leg of a 28-year-old female of 12 years duration.

Keywords: Cutaneous tuberculosis, lupus vulgaris, sporotrichoid


How to cite this article:
Maheshwari A, Tiwari S, Mathur DK, Bhargava P. Sporotrichoid lupus vulgaris: A rare presentation. Indian Dermatol Online J 2015;6:120-1

How to cite this URL:
Maheshwari A, Tiwari S, Mathur DK, Bhargava P. Sporotrichoid lupus vulgaris: A rare presentation. Indian Dermatol Online J [serial online] 2015 [cited 2019 Jun 26];6:120-1. Available from: http://www.idoj.in/text.asp?2015/6/2/120/153017


   Introduction Top


Cutaneous tuberculosis (TB) forms a small proportion of extrapulmonary TB. [1] Studies from India report an incidence of cutaneous TB of 0.1%. [2],[3] Lupus vulgaris is the most common morphological presentation of cutaneous TB that can present as papular, nodular, plaque, ulcerative, vegetating, and tumid forms. It often originates from an underlying focus of TB, typically in a bone, joint or lymph node, and spreads by either contiguous extension of the disease from underlying affected tissue, or by hematogenous or lymphatic spread. It may also occur after exogenous inoculation, [4] or Bacillus Calmette-Guérin vaccination. [5] It is a paucibacillary type of cutaneous TB and occurs in a patient of a moderate immunity. A typical feature of lupus vulgaris is its extremely chronic course, characterized by a slow and steady growth of the lesion over a period of years. Unusual variants include the frambesiform, gangrenous, ulcerovegetating, lichen simplex chronicus, myxomatous, and sporotrichoid types. [6] Herein we report a rare sporotrichoid presentation of the disease.


   Case report Top


A 28-year-old female with family history of TB presented with multiple, asymptomatic, raised skin lesions of variable size and shape over her right lower limb. Lesions first appeared on the upper surface of her right foot 12 years ago [Figure 1] after a thorn prick. Thereafter, they extended steadily upward to her inner thigh, increasing both in number and size. There was a history of scarring at one end of the lesions and extension from the other. Examination of the right lower limb revealed polysized plaques of 4-8 cm diameter with central scarring and peripheral nodularity extending in a linear array from the dorsum of the lateral three toes to the medial aspect of ankle joint, knee joint, and medial aspect of the upper thigh in a sporotrichoid pattern [Figure 2]. The lesion on the dorsum of the foot was also ulcerated. There was matted unilateral inguinal and cervical lymphadenopathy. Hematological investigations are within normal limits. Serology for human immunodeficiency virus was nonreactive. Chest radiograph posteroanterior view and radiograph of the right foot were normal. Mantoux test showed 16 mm induration. Histopathology revealed hyperkeratosis, acanthosis and elongation of the rete ridges with dense dermal granulomas comprising epithelioid cells, Langhan's type giant cells and chronic inflammatory cells, supporting a diagnosis of lupus vulgaris [Figure 3].
Figure 1: Plaque from dorsum of the foot in a sporotrichoid pattern

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Figure 2: Plaque in sporotrichoid pattern

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Figure 3: Histopathology showing granulomas comprising epitheloid cells and Langhan's type giant cells (H and E Stain, ×40)

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A final diagnosis of sporotrichoid-lupus vulgaris was made and the patient referred to the government TB clinic for category I DOTS.


   Discussion Top


Sporotrichoid form of lupus vulgaris is an unusual variant [7] that mimics sporotrichosis, a subcutaneous fungal disease. [8] Bacilli follow the lymphatic channels and during transit, provoke cutaneous granulomatous inflammation resulting in a linear array of papular, nodular and ulcerative lesions over time. It has been shown that sporotrichoid form is more common in children than in adults. The efficient lymphatic drainage in children and high physical activity that makes them prone to trauma may be responsible for this form. [6] As it is a complex process and takes time, this presentation of lupus vulgaris is rare.

 
   References Top

1.
Yates VM, Rook GA. Mycobacterial infections. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 7 th ed. Oxford: Blackwell Scientific Publications; 2004. p. 28.8.  Back to cited text no. 1
    
2.
Sehgal VN, Wagh SA. The history of cutaneous tuberculosis. Int J Dermatol 1990;29:666-8.  Back to cited text no. 2
    
3.
Ankad BS, Beergouder SL, Khageshan AP. Department of Dermatology; Department of Pathology, S. Nijalingappa Medical College, Bagalkot-587102, Karnataka State, India. Glob J Dermatol Venereol 2013;1:4-6.  Back to cited text no. 3
    
4.
Ghorpade A. Tattoo inoculation lupus vulgaris in two Indian ladies. J Eur Acad Dermatol Venereol 2006;20:476-7.  Back to cited text no. 4
    
5.
Tan HH, Seow CS. A review of cutaneous granulomas and lupus vulgaris following BCG vaccination in a skin hospital in Singapore. Ann Acad Med Singapore 2002;31:663-5.  Back to cited text no. 5
    
6.
Khandpur S, Reddy BS. Lupus vulgaris: Unusual presentations over the face. J Eur Acad Dermatol Venereol 2003;17:706-10.  Back to cited text no. 6
    
7.
Ramesh V. Sporotrichoid cutaneous tuberculosis. Clin Exp Dermatol 2007;32:680-2.  Back to cited text no. 7
    
8.
Tobin EH, Jih WW. Sporotrichoid lymphocutaneous infections: Etiology, diagnosis and therapy. Am Fam Physician 2001;63:326-32.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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