Abstract
Sarcoidosis is a systemic disease of unknown etiology. It is characterized by the formation in all or several affected organs of epitheliod cell tubercles without caseation. Lupus pernio is a cutaneous manifestation of sarcoidosis. Tuberculosis is an important differential diagnosis for sarcoidosis and they closely resemble each other. We are reporting a rare case with classical features of lupus pernio who had concomitant pulmonary tuberculosis. Our patient presented with erythematous, indurated, plaques with scaling on the malar area of the face, cheeks and ear lobules which was consistent with lupus pernio both clinically and histologically. There was a history of weight loss (around 15%) and lethargy since 8 years, which coincided with onset of lesions. He developed high grade fever with sweating at night which lasted for more than 2 months and cough with expectoration. Chest examination revealed bilateral basal crepitations and Mantoux test was positive and broncho alveolar lavage showed acid fast bacilli. The patient was treated with anti-tubercular treatment followed by oral prednisolone over 3 months. Cutaneous lesions were treated with topical mild potency steroid along with intralesional triamcinolone. The overall response of the patient to treatment was satisfactory.