Simultaneous Occurence of Papulonecrotic Tuberculid and Erythema Induratum in a Child: A Case Report

Abstract

Hypersensitivity reactions to Mycobacterium tuberculosis (tuberculids) include papulonecrotic tuberculid (PNT), erythema induratum (EI), and lichen scrofulosorum. . These rarely coexist in a child. We, therefore, report coexistence of papulonecrotic tuberculid and erythema induratum in a four-year old male. He presented with two-week history of skin eruptions involving the arm, abdomen and ears. Reddish bumps later appeared on the legs. Examination revealed erythematous papules, with central necrosis, on the lateral aspect of the left upper arm, ear helices and trunk. There were also several symmetrically distributed non-tender erythematous nodules, some with necrosis, on the shins and calves. Histology of the biopsied papules (PNT) revealed intense wedge-shaped necrosis with perivascular inflammation.and of the leg nodule (EI), extensive dermal fat necrosis with granulomatous lymphocytic infiltration. These findings are compatible with TB. Chest-xray revealed hilar and paratracheal adenopathy. Sputum was positive for Mycobacterium tuberculosis DNA using polymerase chain reaction (PCR). He did well on anti-tuberculosis medications. erythema induratum (EI), and lichen scrofulosorum. . These rarely coexist in a child. We therefore report coexistence of papulonecrotic tuberculid and erythema induratum in a four-year old male. He presented with two-week history of skin eruptions involving the arm, abdomen and ears. Reddish bumps later appeared on the legs. Examination revealed erythematous papules, with central necrosis, on the lateral aspect of the left upper arm, ear helices and trunk. There were also several symmetrically distributed non-tender erythematous nodules, some with necrosis, on the shins and calves. Histology of the biopsied papules (PNT) revealed intense wedge-shaped necrosis with perivascular inflammation.and of leg nodule (EI) extensive dermal fat necrosis with granulomatous lymphocytic infiltration. These findings are compatible with TB. Chest-xray revealed hilar and paratracheal adenopathy. Sputum was positive for Mycobacterium tuberculosis DNA using polymerase chain reaction (PCR). He did well on anti-tuberculosis medications.