Sporotrichoid presentation of lupus vulgaris mimicking mycet
The most common form of cutaneous tuberculosis (TB) is lupus vulgaris (LV). Various forms described are plaque, ulcerative, hypertrophic, vegetative, papular, and nodular. Atypical presentation of LV is rare and may lead to delay in diagnosis and hence increase in morbidity. We report a case of sporotrichoid form of LV which was initially suspected as mycetoma.

A 38-year-old, otherwise, healthy male presented with large erythematous-indurated lesion of size 15 cm × 20 cm with multiple asymptomatic pus-discharging sinuses over the right gluteal region which has slowly progressed over the past 12 years. The patient had a history of intermittent fever for the past 3 years. There was no history of weight loss or any other systemic complaints. There was no previous history of TB in the patient or family.

On examination, in addition to the above-mentioned lesion, he had multiple crusted plaques and atrophic scars along the medical aspect of the right lower leg, right groin area, and over the right buttock above the indurated plaque in a linear fashion. The superficial veins of the right leg below the indurated plaque were dilated and very prominent. Based on the history and clinical findings, differential diagnosis of mycetoma and an atypical form of cutaneous TB was made.

The relevant laboratory investigations include raised erythrocyte sedimentation rate (22 mm/h) and positive Mantoux test (>14 mm). Scanty acid-fast bacilli (AFB) were seen on Ziehl–Neelsen staining from pus discharge, and no fungal elements were seen on KOH from pus discharge. Histopathology from the lesional biopsy showed patchy nodular tuberculoid granulomatous infiltrate, and the staining for AFB in histopathology was negative.

Source: International journal of Mycobacteriology

Read more: http://www.ijmyco.org/temp/IntJMycobacteriol83292-1997269_053252.pdf
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