Tuberculosis continues to be endemic in our country. Skin involvement would be underdiagnosed rather than rare. The combination of two clinical forms of skin tuberculosis is even rarer, especially in an immunocompetent boy.
Young 11-years-old boy, with no tuberculosis contagion, has been presenting an asymptomatic plaque papulo-crouteuse on his right knee for 4 months (Figure 1 and Figure 2). Clinical examination reveals homolateral crural adenopathy; non-inflammatory, fistulized to the skin. That would have appeared 3 months before plaque (Figure 3). Skin biopsy confirms the diagnosis of tuberculosis. Anti bacillary treatment allowed a complete cure without recurrence (Figure 4 and Figure 5).
In our country, scrofuloderma remains a common clinical form of skin tuberculosis. Their association with tuberculosis verrucosa cutis is rare though described in India. This would be a reactivation of the disease much more than recontamination or lymphangitic diffusion, which would explain its occurrence in an immunocompetent terrain.
Skin tuberculosis occurs in several clinical forms that can co-exist or complicate each other. So, his management goes first through cognizing and monitoring them, but also raising attentiveness among doctors and patients.
Figure 1: An asymptomatic plaque papulo-crouteuse on right knee.
Figure 2: Global view of the affected leg.
Figure 3: Homolateral crural adenopathy; non-inflammatory, fistulized to the skin.
Figure 4: Crural adenopathies have regressed.
Figure 5: The disappearance of the plaque.