A Case of Lupus Vulgaris

Abstract

A 65-year-old man presented with an asymptomatic, dark-red, firm plaque with well-defined borders in the right cheek. He stated that the lesion had been there more than 30 years and had enlarged very slowly. Histopathological examination of the lesion showed coalescing tuberculoid granulomas with a few Langhans-type giant cells just beneath the epidermis and in the papillary and mid-dermis. Caseation necrosis was absent. Culture of biopsied tissue on Ogawa egg medium was negative. A polymerase chain reaction(PCR) assay did not reveal the presence of mycobacteria in a lesional biopsy sample. Although the tuberculosis culture and PCR did not confirm tuberculosis, a diagnosis of lupus vulgaris was made considering the clinical and histopathological findings. After a 6-month antituberculous therapy, the lesion disappeared. We believe that a diagnosis of lupus vulgaris still depends more on clinical and histopathological findings than on tuberculosis culture or PCR.