Papulonecrotic tuberculid with an atypical presentation

Abstract

The tuberculids constitute the immune-mediated non-infectious cutaneous hypersensitivity reaction pattern to the underlying focus of Mycobacterium tuberculosis antigen in patients with good cell-mediated immunity. Papulonecrotic tuberculid (PNT) is a true tuberculid that usually occurs secondary to the underlying focus of infection which may be in the lymph nodes, lungs, bone, or rarely in other systems. It manifests as asymptomatic symmetric eruptions of erythematous papules with central areas of ulceration and crusting that heals with varioliform scars. PNT presenting as a generalized folliculitis-like lesion and rosettes has not been described earlier. Furthermore, PNT occurring as a hypersensitivity response due to underlying mediastinal tuberculous lymphadenitis (MTL) is rare. We are highlighting a case of PNT secondary to the MTL in a middle-aged woman.