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A rare, decades-long facial plaque in an elderly woman presented diagnostic challenges. Despite tuberculoid granulomas on biopsy, the cause remained elusive, emphasizing clinicopathological correlation for chronic granulomatous dermatoses.

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Area of Science:

  • Dermatology
  • Pathology
  • Infectious Diseases

Background:

  • Chronic, slowly progressive facial plaques can pose diagnostic difficulties.
  • Tuberculoid granulomas on histopathology suggest specific etiological categories but require further investigation.
  • Negative microbiological stains complicate the identification of infectious causes.

Purpose of the Study:

  • To present a case of a chronic facial plaque with uncertain etiology.
  • To highlight the diagnostic challenges in identifying the cause of granulomatous dermatoses.
  • To emphasize the importance of clinicopathological correlation and follow-up.

Main Methods:

  • Clinical presentation of a chronic infiltrative plaque on the nasal dorsum and malar region.
  • Histopathological examination revealing a tuberculoid granulomatous process.
  • Extensive microbiological investigations with negative special stains.

Main Results:

  • A persistent, decades-long facial plaque was observed.
  • Histopathology confirmed granulomatous inflammation, specifically tuberculoid granulomas.
  • Etiology remained undetermined despite comprehensive microbiological testing.

Conclusions:

  • This case underscores the diagnostic challenges posed by slowly progressive facial plaques.
  • Clinicopathological correlation is crucial when microbiological studies are negative.
  • Long-term follow-up is essential for managing chronic granulomatous dermatoses in endemic areas.