Ulcerative lupus vulgaris of face: An uncommon presentation in India - PDF document

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/6374559 Ulcerative lupus vulgaris of face: An uncommon presentation in India Article in The Indian journal of tuberculosis · February 2007 Source: PubMed CITATIONS READS 11 83 4 authors , including: Padmavathy Lanka Lakshmana Rao Lanka GVPIHC&MT, VISAKHAPATNAM-530048. INDIA 56 PUBLICATIONS 272 CITATIONS 31 PUBLICATIONS 153 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Casereport View project All content following this page was uploaded by Lakshmana Rao Lanka on 11 February 2014. The user has requested enhancement of the downloaded file.

Case Report ULCERATIVE LUPUS VULGARIS OF FACE: AN UNCOMMON PRESENTATION IN INDIA L. Padmavathy 1 , L. Lakshmana Rao 2 , N. Ethirajan 3 and B. Krishnaswami 4 (Original received on 3.4.2006. Revised version received on 7.8.2006. Accepted on 8.8.2006) Summary : Tuberculosis affects the population world wide, more among those living in developing countries. The incidence of tuberculosis registered an upward trend even in developed countries, with the advent of HIV infection. Cutaneous tuberculosis accounts for about 1% of cases of extra-pulmonary tuberculosis. Cutaneous tuberculosis presents with various lesions ranging from ulcerative to proliferative or hyperkeratotic lesions. The lesions may sometimes be associated with marked destruction of the tissues resulting in marked disfigurement, especially when it involves face as seen in cases of Lupus Vulgaris. A case of Lupus Vulgaris in a young woman with extensive ulceration of face which responded to ATT resulting in scarring of the face is reported for its rarity amongst Indian population as against western population. [Indian J Tuberc 2007; 54:52-54 ] Key words : Lupus Vulgaris, Cutaneous Tuberculosis . INTRODUCTION commonly affects the trunk and lower extremities 4 while face is most common site of involvement Tuberculosis is a very common disease among Western population 2,5 . A case of ulcerative among the population world wide, especially those Lupus Vulgaris on the face of a young woman is living in developing countries. With the advent of reported. HIV infection the incidence of tuberculosis has registered an upward trend in developed countries. CASE REPORT The disease is caused by Mycobacterium tuberculosis, M. bovis and under certain conditions the Bacillus A 25 year-old woman presented with a single Calmette-Guerin (BCG), the attenuated strain of M. ulcerative lesion on the face of two-year duration. bovis 1 . Extra pulmonary tuberculosis is yet another The lesion initially started as a small papule, which manifestation of tuberculosis the disease quite broke down resulting in an ulcer on the left cheek. common among the people of low socio-economic The ulcer gradually extended to the other cheek. strata in the developing countries, affecting, among Patient had dry cough for more than six months but other sites, skin. gave no history of fever. Both parents of the patient died of pulmonary tuberculosis. Cutaneous tuberculosis, especially Lupus Vulgaris, was described repeatedly in seventeenth On examination, a 15 x 8 cms ulcerated plaque and eighteenth centuries. The word ‘Lupus’ was on the left side of the face, extending over the nasal described by earlier authors to describe lesions of bridge to the right malar region was observed. Ala nasi Cutaneous Tuberculosis. The word ‘Lupus’ meaning was destroyed, more so on the left side (Fig.1). wolf was given to the lesion because of the ulcerating Periphery of the lesion showed ‘ apple-jelly ’ nodules. and devouring character of the lesion 2 . Lupus Patient did not have any nasal symptoms. Vulgaris is a chronic and progressive form of Cutaneous Tuberculosis occurring in individuals Hematological and biochemical with moderate immunity and high degree of investigations were within normal limits. X-ray chest tuberculin sensitivity 3 . Lupus Vulgaris most showed minimal basal consolidation on the left lung. 1. Dermatologist, Urban Health Centre 2. Professor of Pathology & HOD 3. Professor & HOD, Dept. of Community Medicine 4. Professor of Pathology Rajah Muthiah Medical College, Annamalai University, Annamalai Nagar, Chidambaram (Tamil Nadu) Correspondence : Dr. L. Padmavathy, B3, RSA Complex, Annamalai University, Annamalai Nagar - 608 002, (Tamil Nadu) Phone: 04144-238066(R); E-mail: padmavathy.lanka@gmail.com Indian Journal of Tuberculosis

53 L. PADMAVATHY ET AL Fig. 1 . Clinical photograph showing the ulcerative Fig. 3: Clinical photograph showing the healed lesion extending over the malar regions lesion with scar after ATT. and causing destruction of the ala nasi. DISCUSSION The earliest description of Lupus Vulgaris was by Erasmus Wilson in 1865, which compared the lesions to ravages of a wolf and used the word ‘lupus’ (Lupus=Wolf). The adjective - vulgaris, in Lupus Vulgaris reflects the commonness of this condition in earlier times 2 . The synonyms for this condition are Tuberculosis Luposa Cutis and Tuberculosis Luposa 6 . Lupus Vulgaris occurs in individuals with Fig. 2 : Biopsy from the ulcerated lesion, showing immunity produced by previous tuberculous epithelioid cell granuloma and Langhan’s infection. The morphological manifestations are giant cells along with mononuclear closely related to the state of allergy and degree of infiltrate in dermis. X20 H&E. immunity 2 . Hence, Lupus Vulgaris in most instances is a chronic progressive disease, beginning as a small nodule, growing peripherally and forming an ever Right lung was clear. VDRL and ELISA tests for enlarging plaque, character of which is altered by HIV were negative. Sputum smears were negative noticeable changes in epidermis or cutis brought about for AFB by Z.N. stain. by inflammation. If the epidermis becomes hyperkeratotic, the lesion assumes a verrucous Biopsy from the edge of the skin lesion character, or it becomes tumefied if lymph stasis showed a typical tuberculous lesion comprising predominates in the corium. Irrespective of the type epithelioid cell granulomas with Langhan’s giant cells. of the lesion, the basic process remains the same, (Fig.2). the tuberculous inflammation beginning and extending in the cutis exhibiting characteristics unique to Lupus Patient was put on standard ATT and the Vulgaris 7 . ulcer healed completely in six months. However, The bacilli from another reactive focus of gross deformity of nose with destruction of both tuberculosis reach the skin by hematogenous route alae nasi persisted. (Fig.3) Indian Journal of Tuberculosis