Tuberculosis Verrucosa Cutis in an Unusual Site

Dermatological examination revealed multiple, skin-colored, soft to firm plaques and nodules with a smooth surface arranged in an irregular fashion with coarse grooves separating each of them and being 7cm to 10 cm X 4cm to 6cm in their vertical and horizontal extent respectively on either side of the gluteal cleft. Histopathology showed skin with hyperkeratosis, parakeratosis and acanthosis ,dermis showed increase in cellularity of lymphocytes, plasma cells, few neutrophils and foamy histiocytes along with granulomas composed of epithelioid cells and Langhans giant cells (Fig 2).Routine investigations showed Hb-7.8 gm,RBC-3.2 cu.mm,TLC=5370cu.mm,Neutrophils76.2%,Lymphocytes-16.2% Eosinophils-0.6%.Sputum for Acid fast bacilli (AFB) and HIV serostatus were negative. [9] Histopathology of the lesion shows variable degrees of epidermal hyperplasia,papillomatosis.The papillary and reticular dermis demonstrate epitheloid granuloma and mixed infiltrate.Rarely few bacilli are seen.In similar cases with strong clinical suspicion but negative laboratory tests, the response to ATT is of considerable diagnostic value.