Title : Cutaneous tuberculosis masquerading as Pyoderma Gangrenosum
Abstract:
A 53 year old female presented with reddish raised lesion over left anterior shin for 3 years which eventually ruptured into ulcer, lesion gradually increased in size, purulent discharge from ulcer. Patient had similar compliants 2 years back wound debridement was done outside ,which was diagnosed as pyoderma gangrenosum .She did not respond to the prescribed treatment. No history of cough, fever, loss of weight and loss of appetite .Patient is a known case of hypothyroid not on regular medications.
On examination patient general condition was fair. Vitals stable. Systemic examination– normal. On local examination multiple well defined ulcer with irregular border of size varying from 2*3 cm to 4*5 cm over anterior shin, lateral aspect of left leg and left gluteal region. Base is indurated, Margins are irregular, hyperpigmented to erythematous margins, slough present.
USG abdomen – no significant abnormality, CT Chest – no significant abnormality. Medical gastroenterology opinion obtainted, OGD scopy showed antral gastritis. COLONOSCOPY – NORMAL; pus c/s- showed no growth .B/L LOWER LIMB DOPPLER –NORMAL, ANCA profile within normal limits.
BIOPSY from medial aspect of left leg was taken and reported to be dermis showing numerous illdefined granuloma with central necrosis coalesing to necrotic material ,surrounded by epitheloid histiocytes and Langhans types of multinucleated giant cells surrounded by lymphocytes and plasma cells.
impression: Granulomatous dermatitis of possible tubercular origin .Patient was started on Antituberculous therapy and ulcer showed resolution.
