Unrecognized lupus vulgaris, revealed by its treatment

摘要

A 49-year-old woman, without medical or family history, presents since 6 months ago an erythematous-squamous, papularplaque at the centro-facial level that increased very progressively. The physical examination was normal including pleuropulmonary,abdominal and osteo-articular examination. Everything was evolving in a context of apyrexia and conservationof the general state. During her hospitalization, the cutaneous biopsy found a granuloma with epitheliod and giant cellswithout caseous necrosis. The tuberculin IDR was negative. The search of Koch bacillus was negative in the cutaneoussamples and sputum. TPHA/VDRL and HIV serologies were normal. The bacteriological and mycological examinationof the biopsy fragment was negative. The expert gene to identify Mycobacterium tuberculosis was negative and alsothe smears to research leishmania bodies were negative. Despite the absence of diagnosis evidence, an anti-tuberculosistreatment; 2RHZE/4RH regimen, was prescribed and a spectacular amelioration was noted during and many monthsafter the end of the treatment. So, the response to the treatment was the only diagnosis evidence for the lupus vulgaris.