A Newly Emerging Clinical Presentation of Lupus Vulgaris- Case Report of a Bangladeshi Patient

Lupus vulgaris (LV) is more common among all forms of cutaneous tuberculosis (TB). It usually occurs in previously sensitized individuals with moderate high immunity either by direct exogenous inoculation of tubercle bacilli or by hematogenous or lymphatic spread from an underlying focus of infection endogenously. Our patient was a 55year old woman presented with asymptomatic, gradually spreading erythematous plaque over the dorsal surface of the right hand for 1.5 years. Her lesion started as a pus-filled cavity which she could squeezed out and underwent repeated excisions followed by antibiotic therapy, but recurrence occurred every time. Then she was referred to Dermatology department. Her cutaneous examination revealed multiple erythematous papules coalescing to form plaque which was asymptomatic. Diascopy of the lesion revealed brownish yellow colouration but her tuberculin test was negative. As our provisional diagnosis was lupus vulgaris, we proceed for lesional skin biopsy for histopathology which unveiled granulomatous inflammation in mid dermis consistent with lupus vulgaris. Our focus of reporting the case to enlighten the diagnostic challenges, emphasizing the significance of clinical suspicion despite of negative tuberculin test specially in endemic zone of tuberculosis and initiation of early treatment to reduce the morbidity and also sharing knowledge contributing to new