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(a) H and E stained wedge shaped incisional biopsy, bisected from the skin on her trunk. (b) Diffused granulomatous with multiple histiocytes with a background of lymphocytes periadnexal inflammatory cell infiltrate. (c) and (d) Multinucleated giant cell and Touton giant cells. All were suggestive of lupus vulgaris. No acid-fast bacilli were seen.
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fig1
The FNAC from the scalp lesion showed caseous granulomatous inflammation and the biopsy from the skin lesion was suggestive of lupus vulgaris. (Figures 1(a)-1(d)).
a and b well-demarcated skin-colored indurated plaque lesion with the fine-scale on the right side of cheek, chin, chest, and abdomen.
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Despite the treatment with the anti-TB, the indurated plaque skin lesions (Figures 2(a) and 2(b)) became cauliform-like (Figures 3(a)-3(c)) and the boggy scalp lesion became crusted (Figure 4(a)); another skin biopsy was suggestive of juvenile xanthogranuloma.
a,b, and c monomorphic grouped skin-colored papules and sparse discrete skin-colored papules on the chest, back, and left thigh area.
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fig3
Despite the treatment with the anti-TB, the indurated plaque skin lesions (Figures 2(a) and 2(b)) became cauliform-like (Figures 3(a)-3(c)) and the boggy scalp lesion became crusted (Figure 4(a)); another skin biopsy was suggestive of juvenile xanthogranuloma.
Yellowish-crusted plaque with indurated erythematous background on the right side of the anterior scalp and forehead, picture was taken around 9 years of age.
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fig4
Despite the treatment with the anti-TB, the indurated plaque skin lesions (Figures 2(a) and 2(b)) became cauliform-like (Figures 3(a)-3(c)) and the boggy scalp lesion became crusted (Figure 4(a)); another skin biopsy was suggestive of juvenile xanthogranuloma.
(a),(b) Diffuse yellowish-crusted plaque with associated hair loss on the anterior scalp area at 11 years and 3 months (5c) healing scalp lesion after antibiotic and anti TB treatment at the age of 11 years and 6 months.
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She had a yellowish-crusted plaque with an indurated erythematous background on the right side of the anterior scalp and forehead (Figures 5(a)-5(c)), and a well-demarcated skin-colored indurated plaque with a fine scale on the right side of the cheek, chin, chest, and abdomen.
Multiple punched-out scalp lesions and pictures were taken at 12 years and 10 months right after the debridement.
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(a) and (b) Skull X-ray of the 13 years old girl with MSMD from Ethiopia: multiple trans-diploic lesions with inner and outer calvarial bone destruction; findings were suggestive of delayed/arrested sphenoid sinus pneumatization.
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Her Skull X-ray showed multiple punched-out lytic lesions without sclerotic border involving frontal, parietal, and occipital bones bilaterally (Figures 7(a) and 7(b)).
Healing scalp lesions. The picture was taken just recently while being treated at NIAID.
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Now she is not requiring oxygen, she has gained weight and the scalp wound is healing (Figure 8), even though her progress is not satisfactory Hence, bone marrow (BM) transplant is planned and her donors are being investigated for matching.
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