Papulonecrotic tuberculid in a 2-year-old girl: With emphasis on extent ofdisease and presence of leucocytoclastic vasculitis

The clinicopathologic features of childhood papular necrotic tuberculid (PN T) have been detailed in 10 patients. PNT is characterized by symmetric, ac ral papular lesions that undergo necrosis. Despite widespread cutaneous inv olvement, the number of lesions is usually sparse. The extensor aspects of the limbs are usually involved and trunk involvement is uncommon. Vasculiti s, an integral component of PNT, has been documented only once in childhood PNT. We describe PNT in a 2-year-old girl in whom a multitude of lesions w ere present all over the body, including unusual involvement of flexor surf aces of the limbs, trunk, perineum, and vulva. Biopsied tissue revealed the characteristic features of PNT, including leucocytoclastic vasculitis. The re was prompt response to antituberculous therapy. Based on the findings in this patient, we believe that the clinical spectrum of this eminently trea table disease in children must be expanded in terms of distribution and num ber of lesions to Include extensive limb and trunk, perineal, and vulval in volvement; the histopathologic spectrum of childhood PNT must include leuco cytoclastic vasculitis; and adult and childhood PNT share common histopatho logic features, including a common cellular immunohistochemical profile, th ereby suggesting a common pathogenesis.