Papulonecrotic Tuberculid—a Rare Cutaneous Expression of a Common Disease: a Case Report

Cutaneous tuberculosis is rarely encountered in clinical practice, and its diagnosis is often challenging. One of the clinical variants of cutaneous tuberculoisis is papulonecrotic tuberculid (PNT), which likely represents a hypersensitivity reaction to mycobacterial antigens. It typically manifests as symmetrical and recurring skin eruptions with necrotic papules. Herein, we describe a case of a young male who presented with multiple skin lesions that were refractory to topical and oral antibiotics. On examination, he had erythematous papules, plaques, and depressed scars over both lower limbs, buttocks, and anterior abdomen. He also had right-sided cervical lymphadenopathy. On detailed evaluation, he was diagnosed as a case of PNT with tuberculous cervical lymphadenopathy and was started on anti-tuberculous therapy (ATT). He showed a favorable response to ATT, with regression of skin lesions and lymph node. PNT should be considered in patients with recurrent and refractory papulonecrotic skin lesions who have risk factors for tuberculosis. The presence of typical skin lesions, histopathologic findings, and clinical improvement with ATT support the diagnosis of PNT.