In India, two-thirds of cutaneous tuberculosis cases are found to be lupus vulgaris. Lupus vulgaris could be due to primary or secondary infection to Mycobacterium tuberculosis. Innumerable cases of lupus vulgaris, secondary to a systemic affliction i.e., arising from an underlying focus of tuberculosis have been noted. Very few cases of primary lupus vulgaris have been reported. It may appear as a solitary lesion in the skin at a site of primary inoculation such as tattooing or ear-piercing. We hereby report a case of lupus vulgaris in a 21-year-old female following ear-piercing. Cutaneous examination revealed a soft, erythematous plaque-like growth, involving the entire posterior aspect of both ear lobules completely obscuring the site of ear piercing. It also involved the lower one thirds of anterior aspect of both ear lobules. The overlying skin was smooth with few indentations. Histopathological examination (Fig.2) revealed focal hyperplastic changes in epidermis & multiple epithelioid cell granulomas & a diffuse lymphocytic infiltrate in the entire dermis, extending into the subcutaneous fat. On the basis of these clinical features & histopathological examination findings, a diagnosis of lupus vulgaris was made and she was started on anti-tuberculous treatment. The lesions started regressing after 2weeks.
Keywords: Cutaneous tuberculosis, Lupus vulgaris, Ear piercing