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.