Diop A, Ndiaye M T, Ndiaye M, Seck B, Diouf A, Diatta B H, Diallo M, Ly F
Dermatologie, hôpital institut d'hygiène sociale de Dakar, université Cheikh-Anta-Diop de Dakar, BP 7045, Dakar, Sénégal.
Dermatologie, hôpital Aristide-Le-Dantec Dakar, université Cheikh-Anta-Diop de Dakar, Dakar, Sénégal.
Bull Soc Pathol Exot. 2017 Oct;110(4):230-233. doi: 10.1007/s13149-017-0550-5. Epub 2017 Feb 28.
Lupus vulgaris is a common presentation of cutaneous tuberculosis (TB), but its ulcerative or vegetating form also called vorax is rare.We report a case of lupus vulgaris in its vorax form, which occurred in a patient with discoid lupus erythematous. A 42-year-old patient monitored for chronic lupus erythematosus consulted again for a facial tumor and fever. Physical examination revealed painful ulcerative and crusted lesions on an old discoid lupus lesion and covered the entire upper lip. Similar lesions were noted on cheeks. Moreover, there were cervical lymphadenopathy, a bilateral pulmonary condensation syndrome, and dysphonia. Cutaneous histopathology had revealed a tuberculoid granuloma without caseating, and nucleic acid amplification tests (GeneXpert®) performed on sputum were positive. Thus, the diagnosis of multifocal TB with skin involvement of vorax type was confirmed. The outcome was favorable following TB treatment. Our observation is distinctive as it is a granulomatosis and ulcerative form of lupus vulgaris, which occurred on a discoid lupus erythematous lesion. This is a rare form of lupus vulgaris. This scarcity can be explained by diagnostic difficulties as there are numerous differential diagnoses and histopathology is not often helpful.
寻常狼疮是皮肤结核（TB）的常见表现形式，但其溃疡性或赘生性形式（也称为vorax）较为罕见。我们报告了一例寻常狼疮的vorax形式病例，该病例发生在一名盘状红斑狼疮患者身上。一名因慢性红斑狼疮接受监测的42岁患者因面部肿物和发热再次就诊。体格检查发现，在一处陈旧性盘状狼疮皮损上有疼痛性溃疡性和结痂性病变，覆盖了整个上唇。脸颊上也发现了类似病变。此外，有颈部淋巴结病、双侧肺部实变综合征和声音嘶哑。皮肤组织病理学显示为无干酪样坏死的结核样肉芽肿，对痰液进行的核酸扩增检测（GeneXpert®）呈阳性。因此，确诊为累及皮肤的vorax型多灶性结核。抗结核治疗后预后良好。我们的观察具有独特性，因为这是一种发生在盘状红斑狼疮皮损上的肉芽肿性和溃疡性寻常狼疮。这是寻常狼疮的一种罕见形式。这种罕见性可以通过诊断困难来解释，因为存在众多鉴别诊断，且组织病理学往往并无帮助。
