An unusual case of vulval papulonecrotic tuberculid

The tuberculids are a group of rare cutaneous hypersensitivity reactions that occur in response to a distant focus of mycobacterial infection. Typically, Mantoux testing is strongly reactive, and clinical response to antituberculous treatment is rapid. The papulonecrotic subtype is one such clinical variant, consisting of multiple symmetrical papules, often with central necrosis, distributed preferentially over the trunk and limbs. Localized forms are rare, and mainly involve the genitalia in men. We describe a 26-year-old Indian woman with lymphatic and pulmonary tuberculosis (TB) in association with localized papulonecrotic tuberculid of the vulva, which resolved promptly on treating the underlying TB.