A giant mass on the scalp: an unusual presentation of lupus vulgaris (original) (raw)
Related papers
A COMPARITIVE OVERVIEW OF HISTOPATHOLOGY OF GRANULOMATOUS LESIONS OF SKIN
Sarcoidosis. Histopathology remains a time tested tool for establishing a correct diagnosis. Clinical lesions often reveal surprising underlying pathology. Hence carrying out skin biopsies and microscopic study with routine haematoxylin and eosin (H&E) as well as special stains are must in these disorders so that the type and aetiological agent of the granuloma are properly identified. Besides, follow-up biopsies after the commencement of treatment help in evaluation of the response to therapy. Methods: 52 cases were studied over a period of 2 and a half years. Specimens were collected from the patients of skin, surgery and ENT department. A brief clinical history with age presenting symptoms and signs were recorded. Routine investigations like ESR were performed. Comparison of our study was done with others around the country. Results: Most common type of dermal granuloma was leprosy (59.6%) followed by cutaneous tuberculosis (21.1%), Foreign Body (5.7%), Granuloma Annulare (5.7%), Fungal (5.7%), Actinomycosis (1.9%) and Sarcoidosis (1.9%). Dermal granulomas were most common between the age group of 31 – 50 years. In leprosy and cutaneous tuberculosis, males were affected more as compared to females. Conclusion: Leprosywas most common than other dermal granuloma. Most common type of leprosy and tuberculosis were lepromatous leprosy and lupus vulgaris respectively.
Infectious granulomatous dermatoses: Clinico-histopathological correlation in punch biopsy specimens
IP innovative publication pvt. ltd, 2019
Introduction: Granulomatous dermatoses are group of disorders which are caused by varied etiological agents and includes heterogenous lesions but often share a common histological feature of granuloma formation. Leprosy and cutaneous tuberculosis occupies the major proportion of this category. Leprosy is the most common chronic infectious granulomatous dermatoses caused by mycobacterium leprae. Cutaneous tuberculosis has varied mode of presentation. Materials and Methods: The present study is a one year retrospective study carried out in the Department of Pathology. All the skin biopsies of leprosy cases received in histopathology section from September 2016 to August 2017 were reviewed from the archives of the department. Results: Of 168 skin biopsies, 104 cases were included and remaining 64 cases were excluded. Among 104 cases, 96 cases were leprosy and 8 cases were tuberculosis. It included 73 males and 31 females. Most commonly affected age group was 21-40 years. Majority of the patients were found to have hypopigmented patch. Many of cases were borderline tuberculoid (26 cases) followed by lepromatous leprosy (18 cases). Among the 8 cases of tuberculosis, 4 were lupus vulgaris, 2 were cases of granulomatous chelitis and one cases each of papulonecrotic tuberculid and tuberculosis verrucosa cutis. Conclusion: Diagnosis of leprosy cases should be an integrated approach and includes dermatological, histopathological and microbiological examination. Leprosy is the most common infectious granulomatous dermatitis encountered which was presented clinically with hypopigmented patch. It was found to more common in third and fourth decade of life. This is followed by cutaneous tuberculosis.
The Journal of Dermatology, 2006
Lupus vulgaris and scrofuloderma are the opposite poles of cutaneous tuberculosis. Lupus vulgaris of a giant size and scrofuloderma in the vicinity of this lesion were both present in a 70-year-old female patient. The purified protein derivative of tuberculin (PPD) skin test was strongly positive. In histopathological examination, granulomatous infiltration without caseation necrosis was seen in the dermis. The patient was treated with a four-drug therapy consisting of pyrazinamide (25 mg/kg), isoniazid (5 mg/kg), rifampin (10 mg/kg) and ethambutol (15 mg/kg) daily for 2 months, followed by dual therapy with isoniazid and rifampin for 6 months. Her cutaneous lesions significantly regressed after 4 months, leaving keloid scars.
Erythema induratum (Bazin's disease)
Journal of the American Academy of Dermatology, 1989
The clinical and histologic features of 26 cases of erythema induratum are reviewed. The characteristic cutaneous lesions on the legs of middle-aged women were violaceous, indurated nodules, 1 to 2 em in diameter, which were painful, occasionally ulcerated, and could heal with scarring. The diagnosis was confirmed in all patients by a strongly positive Mantoux test result (1: 10,000 dilution) and by clearing of lesions after antituberculosis therapy. The histologic features were varied but were predominantly those of a vasculitis with a paraseptal and lobular panniculitis. Although it was not possible to fulfill the required criteria for diagnosing tuberculosis in these lesions, we believe there is sufficient circumstantial evidence to support the hypothesis that erythema induratum is a true tuberculid. (J AM ACAD DERMA-TOL 1989;21 :740-5.) The cause of erythema induratum, a chronic nodular eruption occurring on the legs of women, remains in dispute. In 1861 Bazin 1 first described the typical skin changes in association with tuberculosis. Since then, numerous authors 2 -5 have contested the tuberculous origin oftbis condition. We reviewed the clinical and histopathologic findings of 26 patients with erythema induratum and provide strong circumstantial evidence for a tuberculous cause.
South Asian research journal of applied medical sciences, 2023
Cutaneous tuberculosis is dangerous. The M. tuberculosis complex causes 1.5-3% of extrapulmonary cases. This chronic illness needs long care. Tuberculous primary complex, commonly known as primary inoculated tuberculosis, is a rare (1%) clinical and histological diagnosis. To provide a histopathological case of primary skin tuberculosis with an unusual clinical presentation and immunization mechanism, to emphasize the significance of early detection to minimize sequelae and infections. A 52-year-old man has rheumatoid arthritis and systemic hypertension. It started with a unilateral localized dermatosis affecting the head in the left malar region characterized by an erythematosus papule of 2 mm in diameter, which at 2 weeks evolved into a 3 mm ulcer accompanied by pain and edema. The injury evolved every month to malar region, eyelids and left atrial pavilion consisting of a 15 cm erythematous myxedematous plate, was evaluated and treated with multiple antimicrobials without improvement, trauma was ruled out, skin biopsy was taken in the presence of two alcohol-resistant acid bacilli and by computed tomography infection by mycobacteria was excluded, skin tuberculosis was diagnosed of the primary skin complex type and treatment was initiated showing clinical improvement at 4 weeks and resolution at 8 months of treatment. The diagnosis of cutaneous tuberculosis presents a significant challenge owing to the diverse range of morphological manifestations. The manifestations observed in these cases have the ability to imitate various skin diseases, encompassing both infectious and non-infectious conditions. Moreover, it is imperative to exclude the existence of systemic tuberculosis in every instance.
Histopathological study of cutaneous granulomatous lesions
IP innovative publication pvt. ltd, 2019
Introduction: Cutaneous granulomatous lesions are very common encountered by pathologist and dermatologists. Granulomatous dermatoses can be seen in infectious as well as non-infectious conditions leading to chronic inflammation. Clinical features are overlapping, a confirmatory causative finding is essential for the management of patient as treatment varies greatly according to cause. Histopathology remains a gold standard for diagnosis as well as further subtyping of granulomatous inflammatory disorders of skin. Materials and Methods: A retrospective study of skin lesion biopsies performed for 2 years and 2 months, from November 2016 to January 2019. Clinical details were obtained from requisition forms and the cases of granulomatous lesions were diagnosed and subclassified with the help of H&E and special stains. Result: The study includes 70 cases. A predominance of male were found with M:F ratio of 1.3:1. 21 to 30 years of age group was the commonest for granulomatous lesions with 34.3% of cases. Infectious granulomatous dermatoses were far high than non-infectious ones. Leprosy remained the major etiology followed by tuberculosis of skin. Conclusion: Leprosy contribute the major cause of granulomatous dermatoses in this study. Histopathology is gold standard for diagnosis and subclassification of cutaneous granulomatous lesion with a proper history and clinical details.
Lupus vulgaris developing at the site of misdiagnosed scrofuloderma
Journal of The European Academy of Dermatology and Venereology, 2003
Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis primarily occurring in developing countries. The recent increase in the incidence of tuberculosis, especially due to human immunodeficiency virus (HIV) infections, has led to a resurgence of extrapulmonary forms of this disease. We describe a case of lupus vulgaris in a 33-year-old woman who had a 5-year history of a slowly growing plaque on her neck. The lesion was located at the site of surgery repairing the scar resulting from the incision of a subcutaneous abscess during childhood. This lesion was misdiagnosed as bacterial abscess. Histopathologic examination of the plaque revealed non-caseating tuberculoid granulomas consisting of lymphocytes, epithelioid and giant cells. Staining for acid-fast bacilli and culture from biopsied tissue was negative. Polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis DNA, performed on a skin biopsy specimen, was positive. A diagnosis of lupus vulgaris developing at the site of a previous misdiagnosed scrofuloderma was made. Conventional antitubercular therapy with rifampicin, isoniazid and ethambutol was administered for 6 months, resulting in resolution of the lesion.
Lupus Vulgaris Simulating Discoid Lupus Erythematosus
International Journal of Dermatology, 1991
An 18-year-old woman reported with reddish, raised patches over the butterfly area of the face, extending to involve the nasal cartilage, upper lip, and medial canthii of both eyes. She was apparently well 2 years ago, when she noticed a small, pea-sized, raised, soft, reddish eruption over the right malar region. It was slowly progressive and enlarged over the period to involve the right malar region, the nose, upper lip, the opposite malar area, and the medial canthii of both the eyes. The lesions were asymptomatic; however, she experienced a foreign body sensation in her eyes, causing frequent lacrimation. There was no history indicative of systemic involvement. History of Bacillus-Calmatte-Guerin (BCG) vaccination was denied by the patient. The skin surface was marked by well-circumscribed, serpiginous plaque(s). The plaques were brownish-red, and were studded with crusts and scales. They were indurated, and induration was marked at the advancing margins. Atrophy at the side of alae nasi was conspicuous. Nasal cartil^age was destroyed, resulting in deformity ofthe nose. The lesions were located over the malar area, the nose, the upper lip, and the medial canthii of both the eyes. The palpebral conjunctivae were affected (Fig. 1). Diascopy was unrewarding", BCG vaccination scar was absent. Total and differential leukocyte count, and blood sedimentation rate were within normal limits, and so also was the skiagram of the chest. Ziehl-Neelsonstained smears for tubercle bacilli were negative. Lowenstein-Jenson medium did not yield growth after 6 weeks. Accordingly, niacin test and formation of pigment to exclude atypical mycobacteria were not possible. Mantoux test was strongly positive, with a reading of 23 mm after 48 hours. The hematoxylin and eosin-stained section revealed the formation of tuberculoid granuloma composed of epithelioid cells, mononuclear cells, and Langhans giant cell, located in the upper dermis. Caseation necrosis was