CPC02 Follicular eruption unravelling a systemic disease: a clinicopathological correlation
Year: 2025
Type: conference-abstract
Abstract: A 27-year-old woman presented to the outpatient dermatology clinic with complaints of nonitchy reddish papules over the trunk and thighs for 2 months. The rash was sudden in onset and rapidly progressive. She also complained of cough with expectoration along with low-grade fever for 6 months. She had experienced a weight loss of 12 kg during this time. General examination revealed bilateral cervical lymphadenopathy with firm, nontender lymph nodes, the largest lymph node measuring 2 × 2 cm. On cutaneous examination, multiple erythematous to violaceous flat-topped follicular papules arranged in a grouped configuration were observed on the abdomen, lower back, chest and inguinal area. The papules measured 2–3 mm and were associated with minimal scaling. On dermoscopy, pale to whitish monomorphic large dots were observed in the perifollicular regions with central blackish follicular openings or plugs and mild scaling in some areas. A 3.5-mm punch biopsy was obtained from the lesion on the abdomen, which on histopathological examination revealed perifollicular epithelioid cell granulomas along with multinucleated giant cells in the upper dermis. Lymphocytic cuffing was present around the granulomas along with mild perivascular lymphocytic infiltrate in the mid dermis. The epidermis was unremarkable. Ultrasound examination of the cervical region revealed bilaterally enlarged cervical lymph nodes (right > left) at level 1–5, with matting observed in the right cervical area (level 4). Necrotic changes were also visualized. Fine needle aspiration cytology (FNAC) from a right posterior cervical lymph node showed many well-formed epithelioid cell granulomas with polymorphous reactive lymphoid cells in the background. Ziehl–Neelsen stain was positive for acid-fast bacilli from the FNAC smear; however, mycobacterial culture was negative. Mantoux test showed a strong positivity, measuring 25 × 25 mm. High-resolution computed tomography scan of the chest was performed, which showed patchy consolidation with multiple centrilobular nodules and interstitial septal thickening of the right lung along with mediastinal lymphadenopathy. A final diagnosis of lichen scrofulosorum with pulmonary tuberculosis (TB) and cervical TB lymphadenitis was made. The patient was subsequently started on weight-based antitubercular therapy (ATT) comprising isoniazid (225 mg), rifampicin (450 mg), pyrazinamide (1200 mg) and ethambutol (825 mg). There was significant clearance of the cutaneous lesions after 2 months of ATT and the patient continues to be under follow-up. Lichen scrofulosorum is a rare tuberculid that occurs in children and young adults. As it can occur in both pulmonary and extrapulmonary forms of TB, a thorough history, cutaneous and systemic examination, and histopathology, microbiology and imaging are essential for prompt diagnosis and early initiation of ATT.
Source: British Journal of Dermatology
Authors: Anubha Dev, Debajyoti Chatterjee, Dipankar De
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4411733370