| Sub-title | |
| Authors | M J Boffa MD, FRCP Brian Farrugia MD, MRCP J S Degaetano MD, FRCPA |
| Abstract | A previously healthy 45-year-old Maltese lady presented with reddish-brown swelling of her right ear lobe. This had been first noted by the patient about 5 years earlier and was asymptomatic but cosmetically upsetting. There had been no response to treatment with various topical antibiotics and corticosteroids and the abnormality was gradually extending. On examination there was soft, reddish-brown infiltration of the lobe and posterior aspect of the right ear. There was no palpable lymphadenopathy and general examination and review of the rest of the skin were unremarkable. Histological examination of an incisional skin biopsy showed granulomatous inflammation with large epithelioid granulomata with focal necrosis (but no frank caseation) and surrounding lymphocytic cuffing. No Leishman- Donovan bodies were visible and special stains for mycobacteria and fungi were negative. Skin cultures for mycobacteria and fungi were negative. Results of chest X-ray, full blood count, creatinine, liver enzymes and angiotensin-1-converting enzyme were within normal limits. HIV serology was negative. A Mantoux test was strongly positive (18mm induration). A diagnosis of lupus vulgaris was made. On further questioning there was no history to suggest previous TB. The patient had no respiratory symptoms and had never lived abroad. She had been vaccinated with Bacille Calmette-Guerin in childhood. Results of chest X-ray and Mantoux test in the other members of her household (husband and daughter) were normal or negative. The patient's ears had been pierced in childhood. The patient was treated with standard antituberculous chemotherapy (rifampicin 600mg daily, isoniazid 300mg daily and pyrazinamide 2g daily for 2 months followed by rifampicin 600mg daily and isoniazid 300mg daily for a further 4 months). There was gradual improvement with a reduction in both the ear lobe swelling and reddish brown discoloration; some atrophic scarring eventually appeared in the previously affected area. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | 16 Issue 01 |
| Pages | 36 - 38 |
| Date | 01/03/2004 |
| Link to journal | |
| Key words | lupus vulgaris, management |