Clinical Profile of Lichen Scrofulosorum, a Cutaneous Manifestation with Focus on Tubercular Lymphadenitis in a 15-Year-Old Male- A Case Report

Lichen scrofulosorum (LS) or tuberculosis cutis lichenoides is a rare form of tuberculid, an immunological reaction to the Mycobacterium tuberculosis bacilli which may be occult or present with primary focus elsewhere in the body. Other typical recognized forms of tuberculid include erythema induratum and papulonecrotic tuberculid. We report a case of LS with tubercular mediastinal lymphadenopathy in a 15- year-old male who presented with asymptomatic, recurrent, multiple papular rashes on the proximal side of both arms, sides of trunk, chest, stomach area, and back, for the last 5 months. Skin biopsy revealed ill-defined epitheloid cell granulomas with moderate perivascular infiltrates of lymphohistocytes in the upper dermis and features compatible with LS. Chest radiograph showed round radiopacity obscuring right hila pulmonary vasculature and contrast-enhanced computed tomography (CECT) of the chest revealed multiple large conglomerated and necrotic homogenously enhancing mediastinal lymph nodes largest (2.6 x 2.3 cm) at the right hilar location. The patient was treated with standard 6 months of anti-tubercular therapy with a treatment extension of another 3 months until complete resolution of the skin lesions and significant reduction in the size of the hilar lymph node on X-ray examination was seen.