Lupus Vulgaris of the Pinna-A Case Report

Document Type: Case Report

Authors

1 Department of Dermatology, Venereology & Leprology, All India Institute of Medical Sciences, GE Rd, Tatibandh, Raipur, Chhattisgarh, India.

2 Department of Otolaryngology Head and Neck Surgery, All India Institute of Medical Sciences, GE Rd, Tatibandh, Raipur, Chhattisgarh, India.

3 Department of Dermatology, Venereology & Leprosy, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, 490020, India.

4 Department of Pathology, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, 490020, India.

Abstract

Introduction:
Lupus vulgaris is the most common form of cutaneous tuberculosis caused by contiguous spread from an underlying infective focus or lymphatic or hematogenous spread. It can also develop at the site of direct inoculation (e.g., tattooing and ear piercing) or Bacillus Calmette-Guerin vaccination. The solitary involvement of the pinna is rare and may face clinicians with a diagnostic dilemma. Herein, we reported the case of a 37-year-old female presenting with lupus vulgaris of the left pinna with a history of ear piercing.
 
Case Report:
Our case was a 37-year-old female presenting with asymptomatic erythematous plaques on the left pinna for 2 years. She had a history of ear piercing done 20 years ago. After 6 months of ear piercing, she suffered from recurrent infections at the site of piercing in the left ear, while the other ear was normal. Two years earlier, she developed a small erythematous papule, which slowly progressed in size to the present status. On examination, well-defined erythematous scaly plaques were noted on the left helix. The histopathology of the skin biopsy showed multiple confluent granulomas consisting of the epithelioid cells and lymphocyte with a focal area of necrosis in the dermis. Acid-fast bacilli were not seen in modified Ziehl-Neelsen (ZN) and routine ZN staining. A final diagnosis of lupus vulgaris was made, and the patient was started on antitubercular drugs. There was a significant resolution of the lesion after 2 months of treatment.
 
Conclusion:
Cutaneous tuberculosis should be considered in the differential diagnosis of chronic nonhealing granulomatous skin lesions developing at the site of ear piercing.
 

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1. Bravo F, Gotuzzo E. Cutaneous tuberculosis. Clin Dermatol 2007;25:173-80.

2. Patra AC, Gharammi RC, Banerjee PK. A profile of cutaneous tuberculosis. Indian J Dermatol 2006; 51:105-7.

3. Gogia S, Agarwal A. Solitary lupus vulgaris of pinna: A rare presentation. Indian J Otol 2013;19:
30-2.

4. Yates V M. Mycobacterial infections. In: Burns T, Breathnach S, Cox N, Griffiths C, eds. Rook’s Textbook of Dermatology. 8th ed. Oxford: Wiley- Blackwell; 2010:31.1-31.41.

5. Horwitz O. The localization of lupus vulgaris of the skin. Acta Tuberc Scand 1960;39: 1-137.

6. Sehgal VN, Waugh SA. Cutaneous tuberculosis. Current concepts. Int J Dermatol 1990;29: 237-52.

7. Kumar P, Mondal A, Lal NR, Gharami RC. Lupus vulgaris in a child: a complication of ear piercing. Indian J Dermatol Venereol Leprol 2014; 80:97.

8. Vaishnavi L, Prasad PVS, Kaviarasan PK. Lupus vulgaris following ear-piercing. Int J Med Res Health Sci 2015;4:899-901.

9. Hendricks WM. Complications of ear piercing: treatment and prevention. Cutis 1991;48:386-94.