PAPULONECROTIC TUBERCULID SECONDARY TO DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX

Background. Papulonecrotic tuberculid is a rarely reported cutaneous r eaction to the mycobacterium bacillus. It is most often encountered in association with tuberculosis. The clinical and histologic picture of the entity is a distinctive one, but the etiology of the disease proc ess is uncertain. Therapy directed against the causative organism is d ramatically successful. Methods. A 35-year-old white man with AIDS was referred to the Dermatology clinic for evaluation of a widespread ski n eruption. The skin lesions were biopsied for histopathology and cult ure. From the cutaneous cultures Mycobacterium avium complex (MAC) org anisms were grown. Results. We report the first case of papulonecrotic tuberculid Manifestation in an AIDS patient with disseminated MAC. Un usual features seen in this case include the predominance of pruritic eschars rather than asymptomatic papules and the confirmation by speci al stains of mycobacterium organisms within the skin biopsy. Papulonec rotic tuberculid has not been previously associated with either MAC or AIDS. Conclusions. Papulonecrotic tuberculid should be a diagnostic c onsideration in immunocompromised patients with MAC Whose clinical and histologic features are compatible with this rare entity.