Papulonecrotic tuberculid; A significant association with systemic tuberculosis

Abstract

Papulonecrotic tuberculid (PNT) is a cutaneous hypersensitivity reaction to Mycobacterium tuberculosis. It is a rare tuberculid with very few case reports. It is a condition that occurs primarily in children and young adults. The patients usually present with crops of dusky red papules or papulopustules in symmetric pattern, with predilection for extensor aspect of extremities and buttocks. Some lesions may have central necrosis and are usually asymptomatic. The lesions can spontaneous heal with atrophic varioliform scar formation. The rash is likely to recur for many years if left untreated, but rapidly resolutes with antituberculosis treatment.

We present a case of a 23-year-old male with recurrent dusky red papules on both elbows and central necrotic ulcers on both legs for two years. One year later, he developed non-productive cough with significant weight loss. In our case, chest symptoms, bilateral cervical lymphadenopathy and typical PNT skin lesions prompt us to start antituberculosis medications despite the lack of microorganism detection from his clinical specimens. After two months into the treatment, his skin findings, chest symptoms and lymphadenopathy remarkably improved and disappeared.