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Papulonecrotic tuberculid: a case report


Introduction: Papulonecrotic tuberculid (PNT) is a chronic, recurrent, and symmetric eruption of necrotising skin papules in crops involving the arms and legs, and healing with scar formation. PNT is an uncommon disorder, occurring in less than 5 % of cases of active TB. The pathophysiology of this disease has remained controversial.

Case: A 31 years old Balinese woman, visited Outpatient Clinic Department of Dermatology and Venereology Sanglah Hospital Denpasar in 8th September 2003, she has complained of recurrent ulcer for 14 years ago. The clinical feature showed papules, multiple ulcer, and scars, symmetrically on her arms, legs and trunk. Mantoux skin test was strongly positive with 13 mm induration. Lymphohystiocytic vasculitis was found on cell pathology examination, there is no evidence of microbial growth in culture, Ziehl-Neelsen staining and PCR was negative. She was given anti-tuberculosis with a rapid improvement after therapy for 6 months with no significant adverse event.

Conclusion: Treatment for six months using anti-tuberculosis drugs provides satisfactory results with clinical improvement in patients with PNT.



  1. Rappeiner G, Wolff K. Tuberculosis and other Mycobacterial infections In: Freedberg IM, Eisen AZ, Wolff K, et al. Eds. Fitzpatrick’s Dermatology in General medicine. 6th edition. New York: McGraw-Hill; 2005; p. 1933-1971.
  2. Tirumalae R, Yeliur I, Anthony M, Georhe G, Kenneth J. Papulonecrotic tuberculid-clinicopathologic and molecular features of 12 Indian patients. Dermatol Pract Concept. 2014;4(2):17-22.
  3. Wilson-Jones E, Winkelmann RK. Papulonecrotic tuberculid: Aneglected disease in Western countries. J Am Acad Dermatol. 1986;14(5):815-826.
  4. Freiman A, Ting P, Miller M, Greenway C. Papulonecrotic tuberculid: A rare form of cutaneous tuberculosis. Cutis. 2005;75(6):341-346.
  5. Jordaan HF, Schneider JW, Schaaf HS, Victor TS, Geiger DH, Van Helden PD, Rossouw DJ. Papulonecrotic tuberculid in children. A case report of eight patients. Am J Dermatopathol. 1996;18(2):172-185.
  6. Quiros E, Bettinardi A, Piedrola G, Maroto MC. Detecton of mycobacterial DNA in papulonecrotic tuberculid lesions by polymerase chain reaction. J Clin Lab Anal. 2000;14(4):133-135.
  7. Tan SH, Tan BH, Goh CL, Tan KC, Tan MF, Ng WC, Tan WC. Detection of Mycobacterium tuberculosis DNA using polymerase chain reaction in cutaneus tuberculosis and tuberculids. Int J Dermatol. 1999;38(2):122-127.
  8. Jordaan HF, Van Niekerk DJ, Louw M. Papulonecrotic tuberculid. Aclinical, histopathological, and immunohistochemical study of 15 patients. Am J Dermatopathol. 1994;16(5):474-485.
  9. Kullavanijaya P, Sirimachan S, Suwantaroj S. Papulonecrotic tuberculid: Necessity of long-term triple regimens. Int J Dermatol. 1991;30(7):487-490.
  10. Barbagallo J, Tager P, Ingleton R, Hirch RJ, Weinberg JM. Cutaneous tuberculosis: Diagnosis and treatment. Am J Clin Dermatol. 2002;3(5):319-328.

How to Cite

Karna, N. L. P. R. V., & Rusyati, L. M. M. (2020). Papulonecrotic tuberculid: a case report. Indonesia Journal of Biomedical Science, 14(1), 4–8.




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