INTERNATIONAL JOURNAL OF CLINICAL AND MEDICAL CASES (ISSN:2517-7346)

Liquenscrofulosorum, also known as tuberculosis cutis lichenoides, is a rare tuberculid that presents as lichenoid eruptions of minute papule, is an uncommon disease and easily misdiagnosed. The lesions are usually asymptomatic, closely grouped, skin colored to reddish-brown papules, often perifollicular. The eruption usually is associated with strongly positive tuberculin reaction. Diagnosis of the lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. We report a case of lichen scrofulosorum in an adult male with a florid medical history. He responded promptly to antitubercular therapy with a complete clearance of the lesions after one month.

Lichen Scrofulosorum; Tuberculid; Antitubercular Therapy

This case highlights the uncommon, easily mis diagnosed but readily treatable case of lichen scrofulosorum.

Liquen scrofulosorum., also known as tuberculosis cutis lichenoides, is a rare tuberculid that presents as lichenoid eruptions of minute papule, is an uncommon disease and easily misdiagnosed. The lesions are usually asymptomatic, closely grouped, skin colored to reddish-brown papules, often perifollicular. 

A 50 -year-old male presented with a history of itching skin rash for 1 month, accompanied by cough and shortness of breath more intense at night, he reports that the lesions started in the face and now is spread all over the body.

An examination revealed Vital signs: BP: 83/59 mmHg,

Pulse: 128, Spo2: 93% HB:7,8 g/dl HGT: 8,9 mmol/L

Skin: Generalized erythematous popular rash over the body from the face till the feet, with some lesions in plaques on the chest, not blister or vesicles.

Mouth: Whitish lesions in the oral mucous extended to the soft paladar.

Chest: A Skin biopsy was planned in consensus with the dermatologist (Figure 1-3).

FBC, Sputum for GeneXpert, culture and cytology, Chest x rays, skin biopsy, CD4,V Load, Hepatitis B.

FBC CD4:9 Cryptococcal Antigen: Negative

WCC: 1,97 V Load: < 50 copies/ml

RCC: 4,00 Hepatitis B: Negative HB:10,9

Sputum: GeneXpert: Mycobacterium TB not detected

Hematocrit:0,348

Culture: Normal respiratory flora isolated

Platelet: 750 Cytology: Mixed non-specific bacterial flora

Fungal organisms detected.

The features are in keeping with Lichen Scrofulosorum.

There is not atypia or invasive malignancy seen.

• Lichen spinulosis
• Psoriasis
•  Mucosis fungoid
  

Fluconazol 200 mg daily x14/7

Allergex 4mg tds

Vit C 1 g daily

Emulsifying ointment as soap

RHZE (150/75/400/275) 4 tablets daily x 2 months

RH (300/150) 2 tablets daily x 4 months.

His skin condition improved within 3 weeks of treatment, patient in the second phase of treatment and the following is his actual skin condition.

Antitubercular therapy started with conventional four firstline drugs (isoniazid, rifampin, pyrazinamide and ethambutol in daily dose regimen) for 2 months followed by two drugs (isoniazid and rifampin) for 4 months. His constitutional symptoms improved within 2 weeks of starting antitubercular therapy, and skin lesions subsided completely within 2 months. The below pictures revealed the improvement after 1 month of treatment. (Figure 4-8).