Papulonecrotic Tuberculid In Pregnancy – A Rare Entity

A 27-year-old primigravida at 7 months of gestation presented with multiple itchy red raised lesions, initially on the lower extremities, later progressing to involve the upper extremities. Examination revealed multiple well-defined erythematous papules and nodules with central necrosis over the bilateral upper, lower extremities, and chest. Differential diagnoses of prurigo in pregnancy, papulonecrotic tuberculid, and acquired perforating disorder were considered. Investigations revealed a positive Mantoux test, and fine-needle aspiration cytology of an enlarged cervical lymph node confirmed Koch’s etiology. Dermoscopy showed a central keratotic plug. The patient was started on antitubercular therapy and showed significant improvement within 2 months, with complete resolution after 6 months, leaving only postinflammatory hyperpigmentation and varioliform scarring.