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.

Primary Cutaneous Chrysosporium Infection following Ear Piercing: A Case Report

Chrysosporium is a large genus of saprophytic fungi that is commonly found in the soil. Infection caused by this organism is rare in humans and typically occurs in immunocompromised patients. Primary cutaneous Chrysosporium infection is relatively rare and has been reported in a heart transplant patient. The prognosis is usually favorable, but very poor in the setting of persistent profound immunosuppression. We herein report a case of primary cutaneous Chrysosporium infection following ear piercing in an immunocompetent patient. It is important for clinicians to consider this condition in patients with slow-onset skin and soft tissue infection following cutaneous injury, even in an immunocompetent setting.

Beyond the borders of keloid formation: A case report

The keloid scar is a cutaneous mass characterized by nodular fibroblastic proliferation of dermis and a predilection for distinctive anatomical locations. However, keloid extension to neighbouring tissue as a nonsyndromic entity has not been described. In the present report, a case involving a 48-year-old woman with extensive bilateral keloids of the ear lobules and neck following ear piercing is presented.

She wants it done

OBJECTIVE

To compare ear piercing practices and complications arising therefrom in British and Sudanese children and to seek possible ethnic, cultural and environmental differences.

SETTINGS

Maelor General Hospital, Wrexham, UK and Wad Medani Children Hospital, Wad Medani, Sudan.

METHODS

Parents of a hundred British children and an equal number of Sudanese parents were requested to fill a questionnaire on ear piercing. All children were examined for possible local or systemic complications.

RESULTS

All parents answered the questionnaire. Eighty-eight (88%) of the British children were girls while all Sudanese children (100%) were girls. Eighty (80%) of the British children had had their ears pierced before they were 6 years old while 90% of Sudanese children had had their ears pierced below that age. The procedure was performed in both groups by non-medical staff. Local inflammation and allergic contact reactions were the commonest complications in both groups. Keloids were only encountered in the Sudanese children. A case of tetanus was encountered in the Sudanese group.

CONCLUSION AND RECOMMENDATIONS

Ear piercing in both communities is performed at a very early age. This procedure is not without complications and the medical profession should advise safety in this practice. Earrings selected should be of non-allergenic material. Regular application of an antiseptic to the site should be encouraged. The community should be made aware of the hazards and complications of ear piercing. With the awareness of these complications and guided with a set of rules, people may continue the practice (she may have it done). Health authorities in Sudan should formulate guidelines that will ensure hygienic measures and reduce complications.