Lichen scrofulosorum and endometrial tuberculosis: a novel association

Lichen scrofulosorum (LS) is a rare tuberculid with an underlying systemic focus of tuberculosis (Tb) detected in majority of cases. The associated Tb foci reported in literature include pulmonary, lymph node, intracranial, abdominal, and cutaneous Tb. We report two women who presented with LS and infertility due to endometrial Tb; an association hitherto undescribed.

Case 1: A 24-year-old woman presented with asymptomatic grouped papules of LS over the trunk associated with secondary infertility. Endometrial biopsy was suggestive of endometrial Tb, and PCR was positive for M. tuberculosis. The skin lesions resolved after 3 months of anti-tubercular therapy (ATT). Case 2: A 27-year-old woman presented with erythematous, grouped, perifollicular papules over the trunk 5 weeks after starting ATT for endometrial Tb that was diagnosed during work up for primary infertility. A skin biopsy confirmed the diagnosis of LS, and lesions resolved with continuation of ATT for 10 weeks.

LS can mimic several dermatologic diseases, and a high index of suspicion is required for the diagnosis and initiation of investigations to detect the underlying Tb focus. A good obstetric history in females will aid in early diagnosis and initiation of appropriate therapy.