A 45-Year-Old Woman With 30-Year History of a Nodule of the Earlobe Diagnosed as Lupus Vulgaris (Cutaneous Tuberculosis).
Xiaoyan Zhang, Yating Xu, Linyi Song et al.
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Case in brief
A 45-year-old woman had a painless, intermittently itchy lesion on her right earlobe for more than 30 years. It appeared as a red, thickened plaque with yellow papules and pustules. Biopsy showed dermal epithelioid cell clusters with dense inflammatory infiltrates; interferon-gamma release assay, Xpert testing, mycobacterial culture, and acid-fast staining supported tuberculosis, and the cultured organism was identified as Mycobacterium tuberculosis. Chest CT showed a previous right upper-lobe lesion. The findings established earlobe lupus vulgaris, and the skin lesions improved significantly after anti-tuberculosis therapy.
What made this case unusual
The lesion persisted untreated for more than 30 years, presenting as a chronic inflammatory focus on the earlobe.
Diagnostic / clinical pearl
For persistent skin nodules, plaques, or ulcers—especially those responding poorly to treatment—consider cutaneous tuberculosis and pursue appropriate testing, including tissue assessment and microbiological studies.