Tuberculosis verrucosa cutis with bilateral pulmonary tuberculosis

A rare case oftuberculosis verrucosa cutis with bilateral pultnonary tuberculosis itr a 28 year-old Indonesian nale is reported. He has been affected by this disease for 16 years. The lesiotr began as a slow growittg, ,to,, pruritic, rough, pauiless, warty lesion, at the dorsal aspect of his right foot. In tlrc last 2 years, the lesiott has thickened, and he noted a warty lesion on his right upper thigh. In thelast6nonthshesufferedfrondrycough,fever,generalnnlaise,andanorexia. Physicale.r.aninationrevealedanafebrile,chronically ill, lean individual, with nornalfunctions. Enlarged regional lytnph nodes of the right groin was fowtd. Cutaneous exatnination showed a finn, slightly red-brown, hyperkeratotic plaque of 5 x 5 cn with crusts and scales proxitnal to the first lesion. On the anterior aspect of the right uppear thigh, there was a serpigitreous, hyperkeraatotic plaque l2 x 5 ctrr itr size, with erosions, pus, blood, crusts, and scales. An apple jelly-like appearance was not present on diascopic exanination. Sigttificant laboratory findings were and elevated blood sedimentation rate of 86 trurlh and nornal liver function tests. Chest x-rays revealed bilateral pulntonary tuberculosis and acid fast bacilli were found in the sputun. The tuberculitt test of PPD 5 TII was strongly positive. Tissue cultures of biopsy specinens for either fungi or mycobacteria were negative. Histopathologic exanination was sugestive of tuberculosis verrucosa cutis. The patient was given 450 nrg rifampicin, 10O0 mg pyrazinatnide, and 300 ng isoniazid daily. Afier 3 weeks of therapy, the skin lesion was altnost healed. The patient did not show up for a follow-up.