38vaishnavi Etal
38vaishnavi Etal
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Case report
DOI: 10.5958/2319-5886.2015.00181.2
Open Access
ARTICLE INFO
th
ABSTRACT
In India, two-thirds of cutaneous tuberculosis cases are found to be lupus
vulgaris. Lupus vulgaris could be due to primary or secondary infection to
Mycobacterium tuberculosis. Innumerable cases of lupus vulgaris,
secondary to a systemic affliction i.e., arising from an underlying focus of
tuberculosis have been noted. Very few cases of primary lupus vulgaris
have been reported. It may appear as a solitary lesion in the skin at a site
of primary inoculation such as tattooing or ear-piercing. We hereby report
a case of lupus vulgaris in a 21-year-old female following ear-piercing.
Cutaneous examination revealed a soft, erythematous plaque-like growth,
involving the entire posterior aspect of both ear lobules completely
obscuring the site of ear piercing. It also involved the lower one thirds of
anterior aspect of both ear lobules. The overlying skin was smooth with
few indentations. Histopathological examination (Fig.2) revealed focal
hyperplastic changes in epidermis & multiple epithelioid cell granulomas &
a diffuse lymphocytic infiltrate in the entire dermis, extending into the
subcutaneous fat. On the basis of these clinical features &
histopathological examination findings, a diagnosis of lupus vulgaris was
made and she was started on anti-tuberculous treatment. The lesions
started regressing after 2weeks.
INTRODUCTION
Tuberculosis (TB) is one of the most common, rampant
infectious diseases in underdeveloped countries. In
countries like India, while great progress has been
made, TB is still very common; with 2.3 million new
[1]
cases diagnosed every year
.The pattern of
cutaneous TB has been changing over the last few
decades. By 1980s the incidence of cutaneous TB in
[2]
India had fallen to 0.15% . More recent reports
suggest that cutaneous TB is again becoming more
[2]
prevalent with incidence of 0.26% . A current problem
is that atypical and even standard presentations may be
overlooked, through lack of familiarity with the various
patterns that may occur.
Among the cases of cutaneous TB reported in India,
[2]
57.69% are found to be that of lupus vulgaris . These
lesions are acquired exogenously or endogenously,
although the former is significantly less common. Lupus
vulgaris can arise at the site of a primary inoculation
such as tattooing, ear piercing or following BCG
immunization.
CASE REPORT
A 21-year-old woman, presented to our out-patient
department, with a history of a fleshy growth in both ear
lobules since 3years. She first noticed the growth, at 2
weeks, following piercing of her ears for attaching
adornments. Interestingly the growth started at the site
of piercing and gradually progressed to involve the
entire posterior aspect of both ear lobules. She did not
complain of pain, itching, bleeding or any form of
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Vaishnavi et al.,
3.
DISCUSSION
Ear piercing has been a popular practice in India since
time immemorial. The risk of acute complications
following ear-piercing, depends on the experience of
the piercer, on the hygiene-sanitation conditions under
which the procedure takes place and on general
piercing aftercare. Specific complications associated
with piercing the pinna include, hypertrophic /keloid
scarring, chondritis / perichondritis & incrustation. The
most common complication is infection, occurring in 10[3,4]
20% of cases . Microorganisms like staphylococcus
aureus, group A streptococci & pseudomonas species
are usually thought to be the causative organisms of
[6]
infections following ear piercing
. Less common
infective organisms associated with piercings are
[4]
coagulase negative staphylococci, Lactobacillus ,
[3,4]
Mycobacterium
tuberculosis
and
atypical
mycobacteria. Among the various forms of cutaneous
TB, lupus vulgaris is most common manifestation as is
[8]
evidently seen in 75% of the cases .
Vaishnavi et al.,
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Vaishnavi et al.,
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Int J Med Res Health Sci. 2015;4(4):899-901