Tasneem Sultan Nakhoda, Naseem Zehra Jafri, Zohra Zaidi, Saleem Sadiq.
Lichen Scrofulosorum with pulmonary Tuberculosis.
J Pak Assoc Derma Jan ;8(1):21-3.

A 19 year female presented to the department of dermatology, JMPC, Karachi with the reddish brown scaly follicullar papules on the trunk and abdomen anteroposteriorly. She had a history of fever, cough with sputum, anorexia skin lesion. Four years prior to this she was treated for pulmonary tuberculosis, albeit she did not recover fully due to lack of compliance. Physical examination did not reveal any concomitent lymphadenopathy, there was no evidence of bony involvement. She appeared to be slightly anaemic with the prexia of 38.2F. Dermatology examination revealed multiple reddish brown annular lesions confluent and perifollicullar papules. The physical examination of other bodily system was normal. Hematological and biological examination were also normal. ESR was 45mm in 1st hour. Mantoux test was positive at 1:10,000 concentration. Chest X-Ray showed bilateral apical scarring,and a dense mass in the left upper zone, sputum culture for Acid Fast Bacilli was negative. Two punch biopsies were taken from the papules from the back, which showed keratin plugging and granulomatous reaction around the hair follicle. The epidermis overlying the follicle showed hyperkerotosis. The patient was started an Anti-Tuberculosis treatment with Isoniazid, Ethambutol, Rifampicin and Pyridoxine. The responce to the treatment was dramatic with the skin lesions disappearing within 10 days of treatment.

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