Association of tuberculous lupus with scrofuloderm
Author(s): A Mejouar, K Baline, F Hali, S Chiheb, I Beliamime and F Mernissi
Introduction: Cutaneous tuberculosis is rare. It ranks fifth. Cutaneous lupus is a rare variant of pauci-bacillary cutaneous tuberculosis affecting subjects with moderate to very high immunity. As for the scrofuloderma, it is a multi-bacillary form of low immunity frequent in our context. We report a case of tuberculous lupus associated with scrofuloderma. Case report: 61-year-old patient, with no notable pathological history, consults for a circumferential placard, squamous erythemato-purulent papillae with a papulo-crusty surface at the distal third of the forearm, wrist and back of the left hand, with scrofuloderms in the ipsilateral epithrochleal ganglionic chain. The rest of the somatic examination was unremarkable. The general state was preserved. Tuberculin intradermal reaction was positive.
Cutaneous biopsy showed non-necrotic granulomatous tuberculoid dermatitis. The diagnosis of tuberculous lupus was strongly presumed. The patient received multidrug therapy. The evolution after six months of treatment was marked by complete disinfiltration of the lesion leaving room for a hypochromic atrophic scar patch.
Conclusion: Lupus tuberculosis is a variant of cutaneous tuberculosis rare in our context. However, it is necessary to think of it in front of a chronic, papular and serpiginous placard of evolution with a central slump and an erythemato-purplish periphery because of the tubercular endemicity of our country.