A report describes a case of a 9-year-old debilitated girl who described a 1½ years history of red-colored lesions over the face along with the destruction of the nose. History revealed it to initiate as a small nodule on the tip of the nose, which collapsed to form an ulcer that involved the adjacent areas with simultaneous destruction of the nose. She was also suffering from a cough for the last 6months without any fever. She lost her father to pulmonary tuberculosis 2 years back.

Examination revealed a large ulcerative plaque with atrophy and crusting over the upper lip and nose with the destruction of both lateral and septal cartilages. The anterior half of the nose was nearly resorbed.Multiple infiltrating erythematous plaques of irregular size and shape were also seen bilaterally on the cheeks and angle of the mouth. Another large atrophic plaque (20 × 10 cm2) with an active erythematous border was also seen over the anteromedial aspect of the right thigh. Enlarged and mildly tender submandibular lymph nodes were noted.

Hematological and biochemical investigations showed mild anemia, lymphocytosis and raised erythrocyte sedimentation rate. X-ray chest revealed air spaces opacities bilaterally in the lung field with parenchymal calcification suggestive of pulmonary tuberculosis. Venereal disease research laboratory and HIV ELISA tests came out to be negative. Ziehl-Neelsen staining of sputum showed positivity for acid-fast Bacilli. Mantoux test was positive with induration of 21 mm read at 48 hours. A deep biopsy specimen revealed epidermal hyperkeratosis and tuberculoid granuloma composed of mononuclear cells and multinucleated Langhans giant cells suggestive of lupus vulgaris.

Source: Jain SK, Mehta P, Gupta S, et al. A pediatric case of disseminated mutilating lupus vulgaris: adisgrace for society. Indian J Paediatr Dermatol. 2016;17(2):148-50.