Pulmonary tuberculosis with Lichen scrofulosorum

A two years old male child presented with fever and erythematous maculopapular rash over the trunk and back since 15 days and oronasal bleed since 4 days. Mother was treated for tubercular lymphadenitis 6 years ago. At that time, family was not screened for tuberculosis. Child was malnourished, pale with oronasal crusting. He also had sub-mandibular lymphadenopathy and hepatomegaly. Islets of closely grouped, reddish brown papules involving abdomen, chest, back and proximal parts of the limbs were seen. ![Figure][1] There was severe anaemia and thrombocytopenia. Mantoux was strongly positive. X ray and CT chest showed hilar lymphadenopathy and histopathology of the lymph node confirmed tuberculosis. Skin biopsy revealed small epitheloid granuloma in upper dermis; suggestive of Lichen Scrofulosorum . ![Figure][1] Child was started on 4 anti tubercular drugs viz Isoniazid, Rifampicin, Pyrazinamide and Ethambutol for six months. Papular rash healed within couple of weeks, after initiation of anti tubercular treatment. [1]: pending:yes