HYPERTROPHIC LUPUS VULGARIS: AN UNUSUAL PRESENTATION

Lupus vulgaris is the most common form of cutaneous tuberculosis occurring in previously sensitized individuals with a high degree of tuberculin sensitivity. Various forms including plaque, ulcerative, hypertrophic, vegetative, papular, and nodular forms have been described. A 30-year-old male patient presented with a very large hypertrophic lupus vulgaris lesion over left side of chest since 22 years. Histopathological examination showed granulomatous infiltration without caseation necrosis. The Mantoux reaction was strongly positive. Hypertrophic lupus vulgaris of such a giant size and that too at an unusual site is extremely rare and hence is being reported.     

DISCOID LUPUS ERYTHEMATOSUS LESIONS DEVELOPED ON LUPUS ERYTHEMATOSUS PROFUNDUS NODULES

We describe this case of LEP for its unusual way of presentation. It first appeared with a LEP pattern, followed by a typical DEE of the skin, overlying the nodules only. Moreover, our histologic findings showed the typical pattern of lymphocytic lobular panniculitis, with hyaline necrosis of fat, the lymphoid nodule, and even the lymphocytic nuclear “dust.” The epidermal changes, with the liquefaction degeneration of the basal cell layer, a moderate follicular hyperkeratosis, and a perivascular and periappendeal lymphocytic infiltrate, were also observed in the abdominal lesion that developed last without clinically evident DLE.     

DIAGNOSTIC EVALUATION OF THE LUPUS BAND TEST IN DISCOID AND SYSTEMIC LUPUS ERYTHEMATOSUS

Background. The usefulness of the lupus band test (lbt ) in the diagnosis of cutaneous lupus erythematosus remains controversial. The study was done to determine the sensitivity, specificity, and predictive value of the lbt in discoid lupus erythematosus (dle ) and systemic lupus erythematosus (sle ). Methods. During the study period, 32 patients with SLE and 28 patients with DLE were included. The final classification of cases was based on the American Rheumatism Association Criteria (ara ) for sle , histopathology, and consensus of the clinical staff. Thirty controls, 15 each for DLE and sle , were chosen from a group of patients, who had lesions clinically simulating dle and sle , but could be excluded by histopathology, laboratory tests, and follow-up. Histopathologic examinations and direct immunofluorescence (DIF) tests were done on lesional skin. Results. In dle , the sensitivity of the LE band test was 58% and the specificity 87%. The positive predictive value was 95% and negative predictive value was 32%. In sle the sensitivity was 93% and specificity 87%. The positive predictive value was 64% and negative predictive value 98%. Conclusions. The high negative predictive value of lbt in sle suggests that it is valuable in excluding diseases clinically similar to sle .     

BULLOUS DISCOID LUPUS ERYTHEMATOSUS: A CASE REPORT

A case of bullous discoid lupus erythematosus is presented. The case had no features suggestive of progression to systemic lupus erythematosus and is believed to be only the second such case reported.     

CLOFAZIMINE (LAMPRENE) IN THE TREATMENT OF DISCOID LUPUS ERYTHEMATOSUS

Clofazimine was administered, over a period of six months, in a dose of 100 mgm per day, to nine patients with discoid lupus erythematosus. There was complete suppression or improvement in every patient but this took up to three months to become evident. The main side effect was a pleasing suntan colour of the skin.     

CHRONIC DISCOID LUPUS ERYTHEMATOSUS IN THAILAND: DIRECT IMMUNOFLUORESCENCE STUDY

Background. Studies of chronic discoid lupus erythematosus (DLE) lesions by direct immunofluorescence (DIF) were heterogeneous with respect to classes of immunoglobulins and sites where these were deposited. Most of the studies were done in the USA and European countries. Materials and Methods. To obtain representative data from Asiatic countries, we analyzed the direct immunofluorescent abnormalities of 100 DLE lesions in Thai patients who were diagnosed on the basis of clinical and histologic criteria. Results. Granular deposits at the dermoepidermal junction (DEJ) were detected in 90% of cases. The common immunoreactants at the DEJ were IgG (63%) and IgM (47%). The deposits were usually combinations of various classes of immunoglobulins, mostly IgG (53%) and IgM (41%). Deposits of IgG and IgM alone at the DEJ were observed in 12% and 8%, respectively. Deposits at colloid bodies, dermal blood vessel walls, and epidermal nuclei were sometimes also seen. Conclusions. The DIF test of skin biopsy specimens is diagnostically significant in chronic DLE. Our study in Thai patients showed that the most common deposit was a combination of various classes of immunoglobulins, mostly IgG and often IgM as well as C3, and occurred at the DEJ of the involved area.     

MYXOID NEUROFIBROMA: AN UNUSUAL PRESENTATION

Myxoid neurofibroma (MN) is a benign tumor of perineural cell origin, which is demonstrated with a positive immunohistochemical staining for S-100 protein. The most common locations of the MN are the face, shoulders, arms, periungual and in the feet. To our knowledge, this is the first time that a trunk location is reported. MN should be included in the differential diagnosis of tumors on this location.