|LETTER TO EDITOR
|Year : 1995 | Volume
| Issue : 5 | Page : 325-326
Kissing lupus vulgaris
M Devinder Thappa, BR Garg, C Ratnakar
M Devinder Thappa
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Thappa M D, Garg B R, Ratnakar C. Kissing lupus vulgaris. Indian J Dermatol Venereol Leprol 1995;61:325-6
| To the Editor,|| |
A 19-year-old male presented with chronic ulcers over both buttocks of 5 months duration. Initially, he noted a small pea-sized raised eruption over the left buttock near midline which 2 weeks later spontaneously ulcerated, discharging seropurulent material. A few weeks latter, patient noticed similar swelling on the right buttock kissing the previous one. There was no history indicative of systemic involvement.
The skin of both gluteal regions was showing oblong obliquely placed plaques, they were brownish red, hyperkeratotic and indurated. Hyperkeratosis was marked at the margins especially over their inner ends. Scarring and pigmentation was apparent in the centres of the plaques. The skin adjacent to the medial ends of the plaques in the natal cleft was not involved. Diascopy was unrewarding. BCG vaccination scar was absent.
Total and differential count and blood sedimentation rate were within normal limits and so also was the skiagram of the chest and lumbosacral spine. Ziehl-Neelson-stained smear for tubercle bacilli was negative. Lowenstein-Jenson medium did not yield growth after 6 weeks. Mantoux test was positive with a reading of 15 mm after 48 hours. The VDRL and HIV tests were non-reactive.
The hematoxylin and eosin stained section of skin lesion revealed the formation of tuberculoid granuloma composed of epithelioid cells, mononuclear cells, langhans and foreign body giant cells located in the dermis. There was not much of caseation necrosis. Secondary epidermal change in the form of hyperkeratosis and acanthosis of the epidermis were present. Acid fast bacilli could not be demonstrated.
Short course treatment regime comprising of INH 300 mg, rifampicin 450 mg and ethambutol 800 mg daily was given for 8 weeks. Favourable response was recorded by regression in the induration as well as hyperkeratosis. The treatment with INH and rifampicin was continued after 2 months, for another 7 months.
The bilateral disposition of lupus vulgaris over the buttocks leaving normal intervening skin in the natal cleft is unusual. This probably resulted from auto-inoculation of the lesion from one buttock to the other.