Case Number : Case 2618 - 20 July 2020 Posted By: Iskander H. Chaudhry

Lupus vulgaris

Please Dr Iskander, what’s the 2608 and 2615 diagnosis?

Trichophyton rubrum folliculitis ( Majocchi’s Granuloma ). 

At first glance this looks like either lichen plano-pilaris or lupus.  However, there are too many neutrophils in the infiltrate and I agree with Vincenzo that an infective folliculitis (fungal or bacterial) is more likely.  Deeper cuts through the follicle would be interesting, as would a PAS and Gram stain.

fungal filaments seen and in dermis vague granuloma with yeast like strictures seen. Need a GMS and PAS stain

How to connect to the lung disease is he on steroids or does he have any other systemic problems like RA with associated lung disease  where he may get Methotrexate. I would not think of CARD 9 mutation at this age where there could be systemic dermatophytosis

waiting for answer eagerly

Tinea

Lovely! Fungual folliculitis, mostly he is receiving an immunosuppressive for his interstitial lung disease  

Majocchi granuloma