Cutaneous tuberculosis and phlyctenular keratoconjunctivitis: a forgotten association

Area of Science:

• Ophthalmology
• Dermatology
• Infectious Diseases

Background:

• Phlyctenular keratoconjunctivitis (PKC) is an ocular inflammatory condition often linked to immunological responses.
• In India, tuberculosis is a common underlying cause of PKC, typically associated with lung or lymph node involvement.
• Cutaneous tuberculosis has rarely been reported as a focus associated with PKC.

Observation:

• This report details two pediatric cases presenting with cutaneous tuberculosis (lupus vulgaris and scrofuloderma) and concurrent PKC.
• One patient also exhibited lichen scrofulosorum, another skin manifestation of a tubercular immunological response.
• These cases suggest a potential link between skin and ocular tuberculosis presentations.

Findings:

• The study identifies a potentially forgotten association between cutaneous tuberculosis and phlyctenular keratoconjunctivitis.
• It demonstrates that skin tuberculosis can be the primary focus in patients with PKC.
• The co-occurrence of multiple tubercular immunological manifestations (skin and eye) is highlighted.

Implications:

• Clinicians should consider cutaneous tuberculosis in the differential diagnosis of PKC, especially in endemic areas.
• This association may necessitate a broader diagnostic approach for patients with PKC.
• Further research is warranted to understand the immunopathogenesis and clinical significance of this link.