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CASE REPORT
Year : 1997  |  Volume : 63  |  Issue : 5  |  Page : 314-316

Pityriasis lichenoides chronica in association with Tubercular Lymphadenitis




Correspondence Address:
R K Pandhi


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Source of Support: None, Conflict of Interest: None


PMID: 20944365

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  Abstract 

A patient with pityriasis lichenoides chronica (PLC) during the course of her skin disease developed tuberculosis of cervical lymph nodes. Anti-tuberculosis treatment resulted in remission of PLC. Mycobacterium tuberculosis could be one of the triggering agent in pityriasis lichenoides.


Keywords: Pityriasis lichenoides chronica, Tuberculosis


How to cite this article:
Pandhi R K, Gupta L K, D'Souza P. Pityriasis lichenoides chronica in association with Tubercular Lymphadenitis. Indian J Dermatol Venereol Leprol 1997;63:314-6

How to cite this URL:
Pandhi R K, Gupta L K, D'Souza P. Pityriasis lichenoides chronica in association with Tubercular Lymphadenitis. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2018 Apr 21];63:314-6. Available from: http://www.ijdvl.com/text.asp?1997/63/5/314/4604


Pityriasis lichenoides chronica (PLC) is a condition characterised by occurrence of small, scaly, red-brown maculo papules. The disease is uncommon and of unknown pathogenesis. We report a case of PLC who developed tuberculous cervical lymphadenitis, the treatment of which resulted in remission of skin lesions.


  Case Report Top


An 18-year-old female was seen with one year history of recurrent crops of multiple, asymptomatic, dull red, scaly papules on trunk, neck and extremities. She reported 4-5 such eposodes, each lasting for 2-3 weeks. There was no history of preceding sore throat or associated constitutional symptoms

The general physical examination and systemic examination did not reveal any abnormality. There was no lymphadenopathy when patient first presented to us. Cutaneous examination revealed 3-5mm sized, slightly raised brownish papules which on scraping showed 'mica' like scaling. The lesions were predominantly present on the trunk, abdomen, arms and thighs. A few scattered lesions were also seen on the face, neck and other parts of the body. Circular to oval, discrete as well as confluent hypopigmented macules of varying sizes were seen interspersed between papules.

Laboratary investigations including a complete haemogram, liver and renal function tests, x-ray chest, urine and stools examination did not reveal any abnormality. Repeated antistreptolysin O (ASLO) titres were normal. Throat swab for bacterial culture was negative. Skin biopsy showed focal parakeratosis, moderate acanthosis, spongiosis and minimal exocytosis, perivascular lymphohistiocytic infiltrate and extravasated red blood cells in the dermis. The features were compatible with pityriasis lichenoides chronica.

The patient was treated with oral tetracycline in the dose of 1 gm/day in 4 divided doses for a period of 2 weeks. Two such courses were given for the acute episodes. The patient continued to develop recurrences. She developed 4 episodes of acute exacerbation during 6 months follow up period. At around the same time she developed enlargement of cervical group of lymphnodes on right side of the neck; the lymph nodes were matted together. The histopathological study of lymph nodes revealed caseating, epitheloid cell granulomas with the presence of acid fast bacilli. The patient was administered 9 months of antituberculosis therapy consisting of 3 drugs rifampicin, isoniazid and ethambutol for a period of 3 months and rifampicin and isoniazid for further 6 months in conventional daily dosage of each drug. The lymphadenopathy completely regressed with the anti-tuberculosis treatment. Interestingly, the patient did not develop any recurrent crop of PLC lesion while on antituberculosis therapy and subsequently thereafter during 2 years post treatment follow up. The patient is under regular surveillance.


  Discussion Top


Pityriasis lichenoides is an uncommon, self-limiting dermatosis with spectrum of clinical changes. At one end is a relatively acute disorder with haemorrhagic papules which heal with varioliform scars - pityriasis lichenoides et varioliformis acuta (PLEVA); at the other end of the spectrum is a less severe disease with small, scaly, red brown maculopapules known as pityriasis lichenoides chronica (PLC).[1]

The pathogenesis of pityriasis lichenoides is unknown. A hypersensitivity reaction to infectious agents has been suggested by the occurrence of small out breaks[2] and by an association with previous upper respiratory tract infections,[3] toxoplasmosis[4] and viral infection.[5]

The evidence that bacterial infection could be contributoy to the pathogenesis of pityriasis lichenoides chronica is suggested by the successful use of antibiotics such as erythromycin [6,7] and tetracycline. [8,9] Piamphongsant[8] in his study on 13 patients of PLC could isolate coagulase positive staphylocci in 4 patients in their throat swab cultures. Other bacteria including coagulase negative staphylocococci, B streptococci, Diplococcus pneumonia and Psuedomonas aeruginosa were also isolated in other patients. Most of his patients showed good clinical response to tetracycline therapy.

We could not demonstrate any focus of infection in our patient when she first presented to us. Repeated antistreptolysin titres (ASLO) were normal. Throat swab cultures for bacteria were repeatedly negative. The patient failed to respond to tetracycline therapy and continued to develop fresh crops of PLC lesions. She, however, showed a remarkable improvement with anti-tuberculosis treatment. The lesions disappeared within a month of starting the therapy and did not recur. The patient continues to stay in remission 2 years after the completion of therapy.

Pityriasis lichenoides has a variable clinical course. Spontaneous remission is known to occur.[6] It could have been possible in our case too. But the association of histologically proven tuberculosis cervical lymphadenitis and the encouraging response of the patient to the anti-tuberculosis therapy strongly suggests a possible role of Mycobacterium tuberculosis in triggering / inducing PLC in our case.



 
  References Top

1.Marks R, Black M, Wilson Jones E. Pityriasi lichenoides: a reappraisal. Br J Dermatol 1972;86:212-225.  Back to cited text no. 1    
2.Szymanski FJ. Pityriasis lichenoides et varioliformis acuta. Arch Dermatol 1959;79:7-15.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Najbrt V. Parapsoriasis guttata et varioliformis deti, Cs Dermatology 1979;54:145-148.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Zlatkov NB, Andreev VC. Toxoplasmosis and pityriasis lichenoides. Br J Dermatol 1972;87:114.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Auster BI, Santa Cruz DJ, Elisen AZ. Febrile ulceronecrotic Mucha-Habermann's disease with interstitial pneumonitis. J Cutan Pathol 1979;6:66-76.  Back to cited text no. 5    
6.Shavin JB, Jones TM, Aton JK, et al. Mucha-Habermann's disease in children : Treatment with erythromycin. Arch Dermatol 1978;114:1679-1680.  Back to cited text no. 6    
7.Truhan AP, Herbet AA, Esterly NB. Pityriasis lichenoides in children : Therapeutic response to erythromycin. J Am Acad Dermatol 1986;15:66-70.  Back to cited text no. 7    
8.Piamphongsant T. Tetracycline for the treatment of pityriasis lichenoides. Br J Dermatol 1974;91:319-326.  Back to cited text no. 8    
9.Shelley WB, Griffith RF. Pityriasis lichenoides et varioliformis acuta : A report of a case controlled by a high dose of tetracycline. Arch Dermatol 1969;100:596-597.  Back to cited text no. 9    




 

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