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Volume 21 Number 1 January 2015 Case Report Multifocal tuberculosis verrucosa cutis

Monica Chahar, Tapan Kumar Dhali, Paschal D'souza, Monica Chahar
Tuberculosis Verrucosa Cutis (TBVC), a verrucous form of cutaneous tuberculosis, occurs from inoculation of tubercle bacilli into the skin of a previously sensitized patient with moderate to high degree of immunity. This disease is now rare in western countries and in India; the incidence of cutaneous tuberculosis has fallen from 2% to 0.15%. However two recent studies from the Indian subcontinent have reported the prevalence of cutaneous tuebrculosis as 0.7% (Varshney et al) and 0.26% (Patra
more » ... and 0.26% (Patra et al) This case is reported to demonstrate the indolent and extensive nature of tuberculosis verrucosa cutis in an immunocompetent individual and to highlight the importance of histopathology and empirical antitubercular therapy as an adjunct diagnostic tool. A 48-year-old man presented with a 15-year history of slowly enlarging asymptomatic plaques over the bilateral feet and buttocks. He initially noticed pea sized painless skin colored papules over his bilateral soles, which gradually increased in size over months. Similar lesions also appeared over the buttocks. The patient denied a history of trauma to the feet even though he used to frequently walk barefoot. There was a history of intermittent discharge of yellow colored pus from the lesions. There was no history of evening temperature elevations, night sweats, chronic cough, or weight loss. One of the patient's close relatives had untreated pulmonary tuberculosis. The patient was otherwise healthy. The patient had been treated initially for a few months with many topical agents (unknown nature) by local practitioners, but with no benefit. Owing to the slow progression of his condition he did not seek medical advice any further. General physical examination was normal with no evidence of lymphadenopathy. A BCG scar was present over the left deltoid region. Cutaneous examination revealed well defined, hyperkeratotic verrucous plaques present over the entire surface of bilateral buttocks and feet. The plaque over the buttocks extended 15 cm over the anterior aspect of the Figure 1. Verrucous plaques over bilateral buttocks and extending over right thigh