A 16-year-old girl presented to our OPD with a lesion in left axilla [Figure 3] which started 10 years back as a small papule in axilla which turned into a pustule within a week which crusted and spread slowly over years.
Patient did not give any history of trauma, prolonged cough, sputum production, fever, night sweats, and weight loss. No family member had cough or sputum production or history of treatment for tuberculosis.
On examination the lesion was sharply demarcated 10 x 6 cm erythematous scaly annular plaque showing peripheral extension and central clearing with atrophic scarring. The plaque extended up to upper inner arm. On diascopy apple jelly nodules were appreciated. No BCG scar was present. There was no axillary or peripheral lymphadenopathy. Tinea corporis was considered as a differential diagnosis, but the lesion was asymptomatic and other flexures and nails were normal. PAS staining was not performed.
Routine investigations and X-ray chest were normal. Tuberculin skin test was positive with an induration of 18 mm.
Biopsy revealed well-formed granulomas with epithelioid cells and Langhans giant cells surrounded by chronic inflammatory cells and central necrosis without AFB [Figure 4, H and E (400x)]. PAS staining was not performed.
Diagnosis of lupus vulgaris was made and she was put on category 1 treatment as per Revised National TB Control Programme (RNTCP) with which the lesions improved.