Vegetating Lupus Vulgaris in a Child

An 8-year-old boy presented with a 6-month progressively enlarging painless nasal lesion, initially misdiagnosed as infiltrative-suppurative trichophytosis and treated with oral griseofulvin and topical sertaconazole without improvement. The patient's father had pulmonary tuberculosis, and the child had not received BCG vaccination. Examination revealed a large, well-defined, red-brown vegetative plaque involving most of the nose. The surface was irregular and moist, covered with adherent yellow-brown and grayish-white crusts. Superficial erosions and small ulcers were present. Several smaller reddish-brown satellite plaques with crusts and fine scaling surrounded the lesion (Figure 1). Biopsy was not performed. Clinical material from the nasal cutaneous lesion was obtained using a sterile swab and cultured in the BACTEC MGIT 960 (an automated culture system for the detection of mycobacteria), yielding Mycobacterium tuberculosis; Xpert MTB/XDR confirmed a drug-susceptible strain. Chest CT revealed focal pulmonary lesions, but the sputum was negative. The patient received 2 months of rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by 4 months of rifampicin and isoniazid (2RZEH/4RH), with visible improvement after 1 month. No recurrence was observed during follow-up. Cutaneous tuberculosis can mimic other granulomatous or infectious diseases. In chronic, nonhealing lesions, lupus vulgaris should be considered in the differential diagnosis, especially in endemic regions [1-3]. Viktor Pushkarenko: data curation, writing – original draft preparation. Yana-Karina Zovdun: conceptualization and methodology. Olga Pushkarenko: Supervision. The authors received no specific funding for this work. The parents/guardians of minor patients have given written informed consent for their child's participation in the study, as well as for the use of their child's de-identified, anonymized, aggregated data, and case details (including photographs) for publication. Ethical Approval: not applicable. The authors declare no conflicts of interest. The data that support the findings of this study are openly available in [repository name, for example, “figshare”] at [doi], reference number [reference number].