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LETTER TO THE EDITOR
Year : 2016  |  Volume : 7  |  Issue : 4  |  Page : 317-318  

Lupus vulgaris in classical sporotrichoid pattern


Department of Dermatology, Venereology and Leprosy, Veer Surendra Sai Medical College, Burla, Odisha, India

Date of Web Publication5-Jul-2016

Correspondence Address:
Swetalina Pradhan
Qr. No. D/6, Near PWD Office, Burla, Sambalpur, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.185491

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How to cite this article:
Dash M, Pradhan S. Lupus vulgaris in classical sporotrichoid pattern. Indian Dermatol Online J 2016;7:317-8

How to cite this URL:
Dash M, Pradhan S. Lupus vulgaris in classical sporotrichoid pattern. Indian Dermatol Online J [serial online] 2016 [cited 2020 Feb 20];7:317-8. Available from: http://www.idoj.in/text.asp?2016/7/4/317/185491

Sir,

A 45-year-old woman presented with multiple, asymptomatic, brownish red elevated lesions of variable sizes over right hand distributed in linear pattern. The lesion started following wood stick injury over right middle finger 3 years back and subsequently progressed proximally to involve the whole hand. Her other medical history and family history were unremarkable. Clinical examination revealed multiple closely placed plaques of various sizes ranging from 0.5 cm × 1 cm to 1 cm × 3 cm with central scarring and elevated peripheral margin in linear pattern over right hand resembling sporotrichosis [Figure 1]a and [Figure 1]b. The right axillary lymph nodes were enlarged and matted. Her HIV status was negative and erythrocyte sedimentation rate was 65 mm in the first hour. Routine laboratory parameters were within normal limit. X-ray of hand and chest was normal. Mantoux test was positive with induration of 25 mm and central vesiculation.
Figure 1: (a and b) Multiple closely placed plaques of various sizes with central scarring and elevated peripheral margin in linear pattern over right hand. (c and d) Clearance of all lesions after treatment

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Histopathology of the lesion showed mild hyperkeratosis, acanthosis, and elongation of the rete ridges with tuberculoid granulomas in dermis comprising epithelioid cells, Langhan's type giant cells, and chronic inflammatory cells, suggesting a diagnosis of lupus vulgaris [Figure 2]c and [Figure 2]d. The patient was diagnosed with sporotrichoid lupus vulgaris and was advised to take antitubercular therapy (ATT) with four drugs isoniazid, rifampicin, pyrizinamide, ethambutol for two months followed by two drugs. The lesions started healing within one month of intake of ATT [Figure 1]c and [Figure 1]d and after two months most of the lesion healed and the patient was advised to complete the course of ATT.
Figure 2: (a) Scanner view, ×40, H and E stain: Mild hyperkeratosis, acanthosis, and elongation of the rete ridges with granulomas in dermis. (b) ×400 view, H and E stain: Epithelioid cells, Langhan's type giant cells, and chronic inflammatory cells in dermis

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Sporotrichoid skin infection refers to conditions that simulate subcutaneous linear lymphangitic form of sporotrichosis.[1] Lupus vulgaris is the most common form of cutaneous tuberculosis and is caused by hematogenous, lymphatic, or contiguous spread from elsewhere in the body.[2],[3] Although it is the most common form of cutaneous tuberculosis, at times the rare morphological patterns can lead to diagnostic dilemma leading to late diagnosis and its consequences. Due to the rising incidence of HIV infection it is always important to diagnose and treat tuberculosis at the earliest to avoid complications such as dissemination.

In our case, the patient presented with multiple lesions of lupus vulgaris placed close to each other in a linear pattern over right hand along with matted axillary lymph nodes resembling sporotrichosis. Although there are few reports of this rare sporotrichoid lupus vulgaris, in our case the lesions were in classical sporotrichoid pattern and there was dramatic response to ATT with complete healing of most lesions on follow up.

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Ramesh V. Sporotrichoid cutaneous tuberculosis. Clin Exp Dermatol 2007;32:680-2.  Back to cited text no. 1
    
2.
Varshney A, Goyal T. Incidence of various clinico-morphological variants of cutaneous tuberculosis and HIV concurrence: A study from the Indian subcontinent. Ann Saudi Med 2011;31:134-9.  Back to cited text no. 2
    
3.
Wozniacka A, Schwartz RA, Sysa-Jedrzejowska A, Borun M, Arkuszewska C. Lupus vulgaris: Report of two cases. Int J Dermatol 2005;44:299-301.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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