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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This is the case of a 15-year-old teenager from Senegal&#46; The patient presented with asymptomatic lesions on his ears and back of his hands that had been spontaneously appearing and recurring over the past year&#46; Upon physical examination&#44; small yellowish skin-colored millimeter-sized papules were seen symmetrically distributed across these regions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1A</a>&#41;&#46; The patient showed no further symptoms&#46; A biopsy of one of the ear lesions revealed the presence of necrotizing granulomas&#46; After several serial Ziehl&#8211;Neelsen stains&#44; a bacillus was finally seen &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1B</a>&#41;&#46; According to the thoracic and abdominal CT scan performed no other organs were involved&#46; Sputum bacilloscopy tested negative&#44; unlike the Quantiferon test&#44; which tested positive&#46; Based on these findings&#44; the patient was diagnosed with papulonecrotic tuberculid &#40;PNT&#41;&#46; After a 1-month oral course with isoniazid&#44; rifampicin&#44; pyrazinamide&#44; and ethambutol&#44; the skin lesions were almost completely gone&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Cutaneous PNT is a rare form of extrapulmonary PNT that has been reported in 1&#8211;2&#37; of the cases&#46; The clinical presentation can vary&#46; It often affects teenagers between the ages of 10 and 14 but can occur at any age&#46; It is mainly due to the presence of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> and less commonly to <span class="elsevierStyleItalic">Mycobacterium bovis</span>&#46; It often has a long course&#46; PNT often presents with recurrent symmetrical outbreaks of papules&#44; pustules&#44; crusts&#44; and even ulcers symmetrically distributed on the face&#44; ears&#44; extensor surfaces of the limbs&#44; trunk&#44; and buttocks&#46; PNT can be preceded by systemic symptoms and often resolves spontaneously within a matter of weeks or months&#44; potentially leaving varioliform scars&#46; The differential diagnosis for PNT includes lichen scrofulosorum&#44; a form of tuberculid&#46; Papulonecrotic forms were originally considered tuberculids&#46; However&#44; DNA from mycobacteria has been detected in them through the polymerase chain reaction &#40;PCR&#41; test&#46; Therefore&#44; it is now suggested that these forms represent true tuberculosis rather than hypersensitivity reactions&#46; In our case&#44; the finding of a bacillus in the skin biopsy and the absence of pulmonary involvement support the latter option&#46;</p></span>"
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Image in Dermatology
Recurrent Papules on the Ears and Hands of an Adolescent
Pápulas recurrentes en las orejas y manos de un adolescente
A. Giacamana,
Autor para correspondencia
anizagiacaman@gmail.com

Corresponding author.
, A. Llull-Ramosa, C. Gómez Bellvertb
a Departamento de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
b Departamento de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This is the case of a 15-year-old teenager from Senegal&#46; The patient presented with asymptomatic lesions on his ears and back of his hands that had been spontaneously appearing and recurring over the past year&#46; Upon physical examination&#44; small yellowish skin-colored millimeter-sized papules were seen symmetrically distributed across these regions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1A</a>&#41;&#46; The patient showed no further symptoms&#46; A biopsy of one of the ear lesions revealed the presence of necrotizing granulomas&#46; After several serial Ziehl&#8211;Neelsen stains&#44; a bacillus was finally seen &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1B</a>&#41;&#46; According to the thoracic and abdominal CT scan performed no other organs were involved&#46; Sputum bacilloscopy tested negative&#44; unlike the Quantiferon test&#44; which tested positive&#46; Based on these findings&#44; the patient was diagnosed with papulonecrotic tuberculid &#40;PNT&#41;&#46; After a 1-month oral course with isoniazid&#44; rifampicin&#44; pyrazinamide&#44; and ethambutol&#44; the skin lesions were almost completely gone&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Cutaneous PNT is a rare form of extrapulmonary PNT that has been reported in 1&#8211;2&#37; of the cases&#46; The clinical presentation can vary&#46; It often affects teenagers between the ages of 10 and 14 but can occur at any age&#46; It is mainly due to the presence of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> and less commonly to <span class="elsevierStyleItalic">Mycobacterium bovis</span>&#46; It often has a long course&#46; PNT often presents with recurrent symmetrical outbreaks of papules&#44; pustules&#44; crusts&#44; and even ulcers symmetrically distributed on the face&#44; ears&#44; extensor surfaces of the limbs&#44; trunk&#44; and buttocks&#46; PNT can be preceded by systemic symptoms and often resolves spontaneously within a matter of weeks or months&#44; potentially leaving varioliform scars&#46; The differential diagnosis for PNT includes lichen scrofulosorum&#44; a form of tuberculid&#46; Papulonecrotic forms were originally considered tuberculids&#46; However&#44; DNA from mycobacteria has been detected in them through the polymerase chain reaction &#40;PCR&#41; test&#46; Therefore&#44; it is now suggested that these forms represent true tuberculosis rather than hypersensitivity reactions&#46; In our case&#44; the finding of a bacillus in the skin biopsy and the absence of pulmonary involvement support the latter option&#46;</p></span>"
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ISSN: 00017310
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