A 57-year-old woman presented with a lesion on the nose that had appeared 8 months prior to consultation. The clinical examination revealed a red infiltrative not well circumscribed plaque (Figs. 1a and 1b). Neither itch nor bleeding was reported No cervical lymphadenopathy was found on palpation. The general condition was good with no fever, neither weight loss nor nocturnal sweats. The past medical history of the patient included appendicectomy and pulmonary tuberculosis treated in childhood.

Figure 1: (a) A red plaque on the nose of a female patient of Russian origin. (b) A red plaque on the lateral aspect of the nose.

DISCUSSION

The answer is D: Lupus vulgaris represents the plaque type and the commonest form of cutaneous tuberculosis and the predominant type in Europe. It accounts for 2% of all extra pulmonary tuberculosis cases. It appears as a red or brownish plaque on the face with no well-defined borders [1]. Other clinical variants include vegetative, tumor, popular or nodular and ulcerative form. It results from hematogenous spread from an endogenous focus of TB or lymphatic or contiguous extension from elsewhere in the body or from direct inoculation of the bacillus from an exogenous source. The definite diagnosis is made by biopsy that reveals granulomas with caseation necrosis in the dermis and an infiltrate of lymphocytes and plasma cells (Table 1) [2].

Table 1: Selected differential diagnosis.

Acne affects younger individuals and presents with mixed inflammatory -red papules-and not inflammatory- white and black comedones.

Rosacea affects middle aged women. Clinical presentation includes red papules and pustules that may coalesce to form plaques. Flushing following exposure to the sun or heat or ingestion of hot and alcoholic drinks also is a feature.

Chronic cutaneous lupus erythematosus is characterized by hyperkeratotic sharply demarcated plaques with atrophy and loss of follicular ostia. Histology is characteristic with atrophy of the epidermis and a lymphocytic infiltrate around hair follicles.

REFERENCES

Notes