An atypical presentation of lupus vulgaris

• Published in: Canadian Medical Association journal (CMAJ) Vol. 189; no. 12; p. E469
• Main Authors: Borretta, Lisa, Green, Peter
• Format: Journal Article
• Language: English
• Published: Canada Joule Inc 27.03.2017; CMA Impact, Inc
• Subjects: Adult; Antibacterial agents; Antitubercular Agents - therapeutic use; Dermatology; Drug therapy; Humans; Infections; Leg Ulcer - diagnosis; Leg Ulcer - drug therapy; Lupus; Lupus Vulgaris - diagnosis; Lupus Vulgaris - drug therapy; Male; Practice; Risk factors; Tuberculosis; Ulcers; Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.160148

A 25-year-old man was referred to the dermatology clinic with a nonhealing ulcer on the front of his right leg, following a localized minor trauma six months earlier. The patient was born in India and moved to Canada in 2012. He had presented to primary care four months after the injury, at which time the ulcer was incised and drained, and treatment was started with oral sulfamethoxazole-trimethoprim and topical mupirocin for a presumed abscess. Initial standard bacterial culture and sensitivity test results were negative. Examination at the dermatology clinic showed a 2.5 x 2 cm violaceous-bordered ulceration (Figure 1). Fungal and mycobacterial cultures were taken to exclude atypical infection. Empirical treatment for pyoderma gangrenosum with topical clobetasol was started. Five weeks later, the culture results returned positive for Mycobacterium tuberculosis.