Lupus vulgaris: Isolation of Mycobacterium tuberculosis from the affected skin scraping and mucous membranes

Abstract

In the second half of the last century skin tuberculosis has become a rarity. With the appearance of resistance to different kinds of pathogenes, HIV-immunodeficiency and decreasing standard of living, the incidence of skin tuberculosis increases. Lupus vulgaris is a chronic form of the secondary tuberculosis of the skin. This is a case report of a 66-year-old woman who presented with a growing, painless, brownish-red, slab-shaped, jelly, cutanesous mass, 2.5 centimeters in diameter, on the tip of her nose, reaching the mucous membrane of the nose. Apart from accelerated erythrocyte sedimentation rate (43/73) and a positive tuberculosis test (Mantoux 10 TU = 25x25 mm), all relevant findings were within reference values. Using Ziehl-Neelsen staining, no acido-resistent bacilli were found. The skin scraping sample, taken from the affected skin and the mucous membrane, was cultivated in Lowenstein medium base, and this resulted with cultivation of Mycobacterium tuberculosis. Using three-drug combination therapy for ten months, complete remission was achieved. Successful cultivation of pathogens represents an absolute diagnostic criterion. We present a case of a woman with lupus vulgaris, because there is a small number of cases documented around the world where the diagnosis was confirmed by culture of Mycobacterium tuberculosis.