Disseminated lupus vulgaris and papulonecrotic tuberculid: Case report

The incidence of tuberculosis and extrapulmonary forms of this disease is i ncreasing all over the world. Lupus vulgaris is the most prevalent form of cutaneous tuberculosis in Europe and the Middle East, Papulonecrotic tuberc ulid, the most common form of hyperergic response to mycobacteria or their fragments, is uncommon in children. We report lupus vulgaris with papulonec rotic tuberculid in a 12-year-old girl who had a 3-year history of slowly g rowing plaques on her trunk, extremities, and the tip of her nose and papul oulcerative lesions over her entire body. A skin biopsy specimen showed min imally caseating granulomatous inflammation, Staining for acid-fast bacilli was negative in both plaques and papules. Polymerase chain reaction identi fied Mycobacterium tuberculosis DNA in the patient's sputum, gastric fluid, and plaques and was negative in the papules. She was started on antituberc ulous therapy with four drugs and her lesions responded rapidly.