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Year : 1995  |  Volume : 61  |  Issue : 3  |  Page : 168-169

Multicentric lupus vulgaris

Correspondence Address:
S Ramachandra

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Source of Support: None, Conflict of Interest: None

PMID: 20952939

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A 60 year old female patient presented with disseminated tuberculosis. She had multicentric lupus vulgaris and her joints, bones, lymph nodes and lungs were also affected. Haematogenous dissemination was because of her poor health.

Keywords: Multicentric, Lupus vulgaris

How to cite this article:
Ramachandra S, Chawla R K, Moorthy R S, Pahwa R S, Bh. Multicentric lupus vulgaris. Indian J Dermatol Venereol Leprol 1995;61:168-9

How to cite this URL:
Ramachandra S, Chawla R K, Moorthy R S, Pahwa R S, Bh. Multicentric lupus vulgaris. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2020 Feb 25];61:168-9. Available from: http://www.ijdvl.com/text.asp?1995/61/3/168/4192

  Introduction Top

The aetiology of all forms of cutaneous tuberculosis is Mycobacterium tuberculosis of human, bovine and very rarely the avium type.[1] Lupus vulgaris is progressive from of cutaneous tuberculosis occurring in individuals with a moderate or high degree of immunity and it is the commonest type of tuberculosis found in India and abroad.[2][3][4] The lesions are usually solitary, but two or more sites may be involved simultaneously. Rarely, multiple foci arise by haematogenous dissemination. One such case is reported here.

  Case Report Top

A 60-year-old undernourished female patient presented with painful swelling and deformity of right elbow, multiple asymptomatic reddish brown plaques and multiple discharging sinuses of 4 years, 1 year and 6 months duration respectively. She had suffered from swellings over sides of neck 15 years ago for which some drugs were taken for 2-3 months. She gave history of loss of weight of about 10 kg over the past one year, however she denied history of fever or chronic cough.

On clinical examination she was found to be emaciated, anaemic and her body weight was 38 kg. Systemic examination revealed her lungs clear but there was soft, non tender mild hepatomegaly. Dermatological examination showed polysized, reddish brown plaques with apple jelly nodules over dorsum of left wrist [Figure - 1], left forearm, left elbow and right upper arm. Scarring was seen in all the plaques. Right elbow joint was grossly swollen, tender and movements were restricted. There was a foul smelling discharging sinus over outer aspect of right elbow [Figure - 1]. A similar sinus was present over medial aspect of lower 1/3 of left leg. Multiple scar marks were seen on the sides of neck. Laboratory investigations showed raised ESR, low haemoglobin (8 g%) and Mantoux test was positive (12 mm). Skiagrams of chest showed non homogenous opacities in both upper right midzones, right elbow showed reduction in joint space and erosion of lateral epicondyle of humerus [Figure - 2] and left leg showed osteolytic lesions with sclerosing margins over lower end of tibia. X-ray left wrist showed haziness of articular margins of carpal bones. Histopathological examination of skin plaque showed typical tuberculoid granulomas in the dermis. However blood sugar, sputum for AFB, LFT including serum enzymes were within normal limits. Blood sent for HIV was found to be negative. Liver biopsy was not carried out in this patient. She was diagnosed and treated with ATT as a case of disseminated tuberculosis.

  Discussion Top

This undernourished patient of disseminated tuberculosis presented with multicentric lupus valgaris lesions on her body. Generally, lupus vulgaris present as one or two plaques with or without involvement of systemic organs. Special feature in our case was alongwith multiple skin lesions, her joints, bones, lungs and lymph nodes were also affected. Multiplicity of skin lesions and her multiple joint and bone involvement was because of her poor health and haematogenous dissemination.

  References Top

1.Christiansen JV. Lupus vulgaris gigantea caused by Mycobacterium avium. In : proceedings of the 13th International Congress of Dermatology, Vol II, editors, Jadasohon W and Scihirren CG. New York : Springer Verlag, 1968;1319-20.  Back to cited text no. 1    
2.Singh G. Lupus vulgaris in India. Ind J Dermatol Venereol 1974;40:257-60.  Back to cited text no. 2    
3.Li Hung-Ching. A Prelminary study of tuberculosis of skin in Peking. Chinese J Dermatol 1957;5:13.  Back to cited text no. 3    
4.Neves H. Evidence of skin diseases 1952-65. Trans St John's Hosp Dermatol Soc London 1966;52:255.  Back to cited text no. 4  [PUBMED]  


[Figure - 1], [Figure - 2]

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1 Lupus vulgaris on keloid
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Indian Journal of Dermatology, Venereology and Leprology. 2002; 68(3): 147-148


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