Facial Plaque with Cut-guava Appearance

An 11-year-old girl presented with a 6-month history of raised reddish lesion on her right cheek. It began as an erythematous papule and progressed to a 3 cm × 3 cm plaque with central atrophy and telangiectasia, as well as a few infiltrating papules along the periphery and a hypopigmented halo. The lesion resembled that of a cut tropical pink guava appearance [Figure 1]. Diascopy of the lesion revealed apple jelly nodules. On further investigations, the Mantoux test was negative and chest X-ray was normal. QuantiFERON-TB Gold was found to be negative.Figure 1: Erythematous plaque with central atrophy and telangiectasia, with a few infiltrating papules along the periphery and a hypopigmented haloHistopathological examination revealed thinned out epidermis with focal parakeratosis. There were several poorly formed granulomas in the dermis composed of epithelioid histiocytes and dense lymphocytic infiltrate. A diagnosis of lupus vulgaris was made. An extra-pulmonary tuberculosis regimen was initiated. At follow-up, regression of the lesions was noted. Lupus vulgaris in children is rare and most commonly involves extremities and face following trauma. Mycobacterium tuberculosis, Mycobacterium bovis, and under certain conditions Bacillus calmette-guerin (BCG), an attenuated strain of M. bovis have been considered as the causative agents of lupus vulgaris.[1] The diagnosis is primarily based on the Mantoux test, histopathology, demonstration of mycobacterium in the tissue or culture, and response to treatment.[2] The Mantoux test will be of limited value in a developing country such as India with high exposure to Mycobacterium leprae and BCG vaccines. Declaration of patient consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.