Lichen Scrofulosorum Without Mantoux Positivity in a 72-Year-Old Male: A Clinical Paradox

TL;DR

A 72-year-old man showed lichen scrofulosorum without a positive Mantoux test, highlighting the need for thorough diagnosis in rare cases.

Contribution

This case report documents an atypical presentation of lichen scrofulosorum with negative Mantoux test in an elderly patient.

Findings

Lichen scrofulosorum can occur without a positive Mantoux test in older adults.

Comprehensive diagnostic workup is crucial when atypical clinical features are present.

Histopathological analysis is essential for confirming the diagnosis in such cases.

Abstract

Lichen scrofulosorum (LS) represents a cutaneous hypersensitivity reaction to Mycobacterium tuberculosis (MTB) in individuals with preserved cell-mediated immunity. It typically presents as asymptomatic, monomorphic papules, predominantly distributed over the trunk, and demonstrates a prompt response to anti-tubercular pharmacotherapy. While the Mantoux test is usually strongly positive, this case highlights the atypical occurrence of Mantoux negativity in a 72-year-old patient, an age group in which LS is rarely encountered. This case emphasizes the need for a comprehensive diagnostic workup, including histopathological analysis and other relevant investigations, when the Mantoux test yields an unexpected result. A keen clinical eye and strong diagnostic suspicion are essential to identifying LS in the context of such atypical features.

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