Disseminated lupus vulgaris without underlying active pulmonary tuberculosis

Lupus vulgaris (LV) is the most common paucibacillary form of cutaneous tuberculosis endemic in Nepal.1 Due to high degree of host immunity, lesions are mostly solitary and localized to face, neck and extremities.2 In the Asian subcontinent, predominant sites involved are the thighs, legs and buttocks.3 Disseminated LV is a rare finding and its occurrence without underlying active pulmonary tuberculosis is even rarer.4 Patients present with slowly progressive plaques preceded by apple jelly nodules, over normal skin and over sites of previous scarring.5 LV usually occurs from an underlying primary focus of infection such as lymph node or bone. However, in the disseminated forms, presence of an active pulmonary tubercular focus is a frequent finding. This association with underlying tubercular foci warrants systemic screening for underlying infection. Given the high host immunity and the low number of bacilli, diagnosis of LV is often challenging.5 If a Mycobacterium tuberculosis polymerase chain reaction test is not available, the diagnosis is made on clinicopathological grounds and correlation with AFB staining.2 Herein, we present the case of a 75-year-old male with disseminated LV without active pulmonary tuberculosis and significant improvement and prevention of complications after anti tubercular therapy (Figure 1). Prajwal Pudasaini, Sushil Paudel, Sagar GC, and Sadiksha Adhikari contributed to the collection of data and the management of the patient. Prajwal Pudasaini and Sushil Paudel wrote the initial draft of manuscript. Prajwal Pudasaini, Sushil Paudel, Sagar GC, Sadiksha Adhikari, and Prashanta Pudasaini revised and prepared the final version of the manuscript. All authors have read and approved the final manuscript and agree to take full responsibility for the integrity and accuracy of the work. The author declare no conflict of interest. This study was conducted after approval from the Institutional Review Board (IRB) of the host institute and the patient in this manuscript has given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.