Lupus vulgaris is the most frequent manifestation of
cutaneous tuberculosis, but in Europe it is limited to isolated cases. Mainly immunocompetent individuals are affected by this result of an endogenous
reinfection on a lymphogenous-less frequently hematogenous-pathway.
Lupus vulgaris has been observed to develop in more than 50% of all patients who already suffer from other manifestations of
tuberculosis. The development of a
squamous cell carcinoma in the
lupus vulgaris is a rare complication; therefore,
lupus vulgaris is deemed a facultative precancerosis.A 68-year-old female Serbo-Croatian patient presented with an extensive ulcerative nose and facial
tumor. Her anamnesis included a
squamous cell carcinoma of the nose that had been excised alio loco 3 years before. Further examinations revealed enlarged cervical
lymphoma on both sides, and pulmonary
metastases were also suspected. The
tumor biopsy revealed a necrotic, granulomatous
inflammation. No
acid-fast rods were seen on Ziehl-Neelsen
stain. The tuberculous origin of this ulcerative skin
tumor-the
lupus vulgaris-as an endogenous
reinfection of
pulmonary tuberculosis manifestation was confirmed by the detection of Mycobacterium tuberculosis
DNA in polymerase chain reaction and the growth of Mycobacterium tuberculosis colonies in the bacterial culture (skin biopsy and bronchial secretion). The skin
tumor as well as the pulmonary manifestation were successfully treated with combined tuberculostatic
therapy and showed a dramatic response within 3 months.