English

Abstract

Lichen scrofulosorum, also known as cutis lichenoides, is a rare tuberculid that presents as a lichenoid eruption of minute papules in children and adolescents with tuberculosis. The lesions are usually asymptomatic, closely grouped, skin-colored to reddish-brown papules, often perifollicular, and are mainly found on the abdomen, chest, back, and proximal parts of the limbs. The eruption is usually associated with a strongly positive tuberculin reaction. We report a case of lichen scrofulosorum in an adult male following Mantoux tuberculin skin test. A 33 year old male patient came with the complaints of small raised skin-colored lesions over the left forearm and back for the past one week. No history of itching associated with it. There was no history of fever, cough, anorexia, weight loss or any other systemic symptoms. No history of exposure to the risk of acquiring Sexually Transmitted Infections. He also gave history of a strong positive reaction of Mantoux test which he underwent one month back as advised by a chest physician. The raised skin-colored lesions initially started in the left forearm at the site of Mantoux test and he developed similar lesions over the back and the right forearm in the next few days. History of BCG Vaccination was present. Family history of tuberculosis is present. His father is a known case of pulmonary tuberculosis that has completed the treatment. Earlier he had gone to the chest physician for the fear of contacting Tuberculosis from his father. Chest Physician had advised Chest skiagram, Sputum for AFB, ESR and Mantoux Investigations. His Chest Skiagram was within Normal Limits and Sputum was negative for AFB. His ESR was 42mm after one hour and Mantoux Intradermal test was strongly positive (25 mm). On Dermatological examination, multiple perifollicular, skin coloured to hypo pigmented smooth scaly papules seen in groups over the left and over the back. Multiple skin coloured to hypo pigmented similar papules are seen in an annular fashion along the periphery of the Mantoux tuberculin test site. No excoriations seen. No koebnerisation seen. General Examination including lymph nodes were normal. Cardiovascular, Respiratory and Central Nervous System Examination were normal. Examination of scalp, oral cavity, genitalia, palms, soles and nails were normal. Based on the history and the classical clinical features, a diagnosis of Lichen scrofulosorum was made. Other differential diagnosis that was considered is lichen nitidus, secondary syphilis and lichenoid sarcoid. He was explained about the condition and advised skin biopsy and VDRL.