title: Verrucous tuberculid mimicking Kyrle disease.
abstract: Cutaneous tuberculosis shows wide clinical variation depending upon the virulence of the organism and host immunity. Tuberculids are difficult to diagnose since the organism often cannot be identified or isolated by microscopy, culture or polymerase chain reaction. The diagnosis rests primarily on the identification of a tuberculous focus elsewhere in the body and response to antitubercular therapy. We present the clinicopathological features of an unusual tuberculid in a 30-year-old man, remarkably mimicking Kyrle's disease. He presented with multiple, symmetrically distributed follicular and perifollicular verrucous papules, nodules and plaques on the face, earlobes and extremities since 4 years. Histopathology revealed parakeratotic follicular plug invaginating into the dermis with multiple caseating epithelioid cell granulomas. PCR for M. tuberculosis was negative. The identification of associated axillary tubercular lymphadenitis, strongly positive Mantoux reaction, tuberculoid granulomas on histopathology and complete resolution of the lesions with antitubercular therapy helped in making the diagnosis. We propose the term "verrucous tuberculid" for this entity.
authors.affiliation: Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. sujaykhandpur@yahoo.co.in
authors.forename: Sujay
authors.initials: S
authors.lastname: Khandpur
authors.forename: Arika
authors.initials: A
authors.lastname: Bansal
authors.forename: M
authors.initials: M
authors.lastname: Ramam
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Sharma
authors.forename: Anup Kumar
authors.initials: AK
authors.lastname: Das
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Singh
authors.forename: H Krishna
authors.initials: HK
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006099:Granuloma / Q000473:pathology; D006801:Humans; D007642:Keratosis / Q000175:diagnosis; D008297:Male; D012871:Skin Diseases / Q000175:diagnosis*; D014374:Tuberculin Test; D014382:Tuberculosis, Cutaneous / Q000175:diagnosis* / Q000188:drug therapy; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis
chemical_list: D000995:Antitubercular Agents