Lupus Vulgaris of the Pinna-A Case Report

INTRODUCTION: Lupus vulgaris is the most common form of cutaneous tuberculosis caused by contiguous spread from an underlying infective focus or lymphatic or hematogenous spread. It can also develop at the site of direct inoculation (e.g., tattooing and ear piercing) or Bacillus Calmette-Guerin vaccination. The solitary involvement of the pinna is rare and may face clinicians with a diagnostic dilemma. Herein, we reported the case of a 37-year-old female presenting with lupus vulgaris of the left pinna with a history of ear piercing. CASE REPORT: Our case was a 37-year-old female presenting with asymptomatic erythematous plaques on the left pinna for 2 years. She had a history of ear piercing done 20 years ago. After 6 months of ear piercing, she suffered from recurrent infections at the site of piercing in the left ear, while the other ear was normal. Two years earlier, she developed a small erythematous papule, which slowly progressed in size to the present status. On examination, well-defined erythematous scaly plaques were noted on the left helix. The histopathology of the skin biopsy showed multiple confluent granulomas consisting of the epithelioid cells and lymphocyte with a focal area of necrosis in the dermis. Acid-fast bacilli were not seen in modified Ziehl-Neelsen (ZN) and routine ZN staining. A final diagnosis of lupus vulgaris was made, and the patient was started on antitubercular drugs. There was a significant resolution of the lesion after 2 months of treatment. CONCLUSION: Cutaneous tuberculosis should be considered in the differential diagnosis of chronic nonhealing granulomatous skin lesions developing at the site of ear piercing.