Lupus vulgaris responding to double antituberculous therapy

Area of Science:

• Dermatology
• Infectious Diseases
• Microbiology

Background:

• Tuberculosis (TB) is a significant global health concern, primarily affecting the lungs but capable of causing extrapulmonary manifestations.
• Cutaneous tuberculosis, though less common, presents a diagnostic challenge, especially when initial treatments for presumed bacterial or fungal infections are ineffective.
• Scrofuloderma, a form of cutaneous TB, involves direct extension from underlying infected lymph nodes or bone.

Observation:

• A patient presented with a 3x4 cm ulcerated facial lesion on the nose and upper lip.
• Previous treatments with broad-spectrum antibiotics and antifungals for a presumed mixed infection yielded no improvement.
• The patient had a documented history of pulmonary and pharyngeal tuberculosis, as well as scrofuloderma affecting cervical lymph nodes.

Findings:

• The persistent facial ulcer was ultimately attributed to a manifestation of tuberculosis.
• Treatment with a standard anti-TB regimen, including isoniazid, rifampin, and pyridoxine, led to a significant clinical response.
• This suggests a tuberculous etiology for the refractory facial ulceration.

Implications:

• This case underscores the importance of considering tuberculosis in the differential diagnosis of chronic, non-responsive facial ulcers, particularly in patients with a history of TB.
• Early recognition and appropriate anti-TB therapy can prevent further complications and improve patient outcomes.
• Clinicians should maintain a high index of suspicion for extrapulmonary TB, including cutaneous forms, in endemic areas or in patients with relevant exposure history.