Cutaneous tuberculosis-unusual presentation

Lupus vulgaris (also known as Tuberculosis luposa) are painful cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around the nose, eyelids, lips, cheeks, ears] and neck. Eighty percent of the lesions are on the head and neck. It is the most common M. tuberculosis skin infection. It is chronic, post primary, pauci bacillary cutaneous tuberculosis found in individuals with moderate immunity and high degree of tuberculin sensitivity. We present a case of 45yr old diabetic and hypertensive female who presented with thickening of skin of feet with hyper pigmentation (since4-5 yrs ),small hyper pigmented painful itchy areas on both breasts (since 1 yr) .Chest radiography showed honeycomb like cystic lesions in lower zone but no evidence of active tuberculosis . Skin biopsy revealed granulomas suggestive of tuberculosis. This case highlights the importance of cutaneous manifestations of systemic disease and is an example of the unusual presentation of lupus vulgaris in a patient.