Simultaneous Occurrence of Papulonecrotic Tuberculid and Erythema Induratum in a Patient with Pulmonary Tuberculosis

Although papulonecrotic tuberculid is an uncommon cuta- neous manifestation of tuberculosis (TB) associated with Mycobacterium tuberculosis infection, the simultaneous occurrence of papulonecrotic tuberculid and erythema induratum is even rarer. Papulonecrotic tuberculid occurs predominantly in young adults and is characterized by eruptions of necrotizing papules that heal with varioliform scars. Histopathologic find- ings include wedge-shaped necrosis of the dermis, poorly formed granu- lomatous infiltration, and vasculitis. Stainings and culture for acid-fast bacilli from skin biopsies are usually negative for M. tuberculosis, although the eruptions resolve with antitubercular therapy. Few patients with papulone- crotic tuberculid, especially with concurrent occurrence of erythema indu- ratum, have been reported in the English literature. Here we report a case of a 12-year-old girl with simultaneous occurrence of papulonecrotic tuberculid and erythema induratum accompanying pulmonary TB.