[Multifocal lupus vulgaris]

Lupus vulgaris is a subset of cutaneous tuberculosis, classically considered as the resurgence of an endogenous focus. The most usual clinical picture is a unique, often facial, patch and the association with deep, visceral specific lesions is rarely reported.

A 69-year-old woman was referred for evaluation of multiple patches of the trunk and the limbs, with a histological picture of non caseating tuberculoid granuloma. A previous medical history of tuberculous primary infection of the lungs prompted search for lupus vulgaris, confirmed by the culture of cutaneous lesions. Numerous visceral specific lesions were likely present, especially in the liver.

Multiple lesions are rarely reported in lupus vulgaris and may be confusing especially with sarcoidosis when confronted with non-specific granulomatous histology. This is especially true when there is visceral involvement, infrequently described in lupus vulgaris (a liver lesion has not been previously reported). Culture of cutaneous samples is required in case of doubt.