PMC5350300_01
Plaque with warty surface on forehead.
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Lesion started as a small papule after 3 months following a roadside fall 2 years back, gradually increased in size, and spread in an annular fashion to form a plaque with warty surface [Figure 1], which started showing ulceration in last 3 months.
(a) Pseudoepitheliomatous hyperplasia with hyperkeratosis and acanthosis [H and E (40x)]. (b) Pseudoepitheliomatous hyperplasia with hyperkeratosis and acanthosis [H and E (400x)]. (c) Dense inflammatory infiltrates with epithelioid cells and giant cells in the dermis [H and E (400x)]. (d) Ziehl-Neelsen Staining showing scant AFB [ZN Staining (1000x)].
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A punch biopsy from the lesion showed pseudoepitheliomatous hyperplasia with hyperkeratosis, acanthosis [Figure 2(a), H and E (40x), and Figure 2(b), H and E (400x)], and dense inflammatory infiltrates with epithelioid cells and giant cells in the dermis with few acid fast bacilli (AFB) [Figure 2(c), H and E (400x), and Figure 2(d), ZN Staining (1000x)].
PMC5350300_02
Erythematous scaly annular plaque in left axilla extending up to upper inner arm.
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fig3
Biopsy shows well-formed granulomas with epithelioid cells and Langhans giant cells surrounded by chronic inflammatory cells and central necrosis [H and E (400x)].
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fig4
Biopsy revealed well-formed granulomas with epithelioid cells and Langhans giant cells surrounded by chronic inflammatory cells and central necrosis without AFB [Figure 4, H and E (400x)].