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Dermatology · Cutaneous tuberculosis: lupus vulgaris
Sample itemA woman has a slowly enlarging red-brown plaque on the face with soft nodules that look yellowish-brown, like apple jelly, when pressed with a glass slide. What is the diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Lupus vulgaris
Lupus vulgaris is a chronic progressive form of cutaneous tuberculosis in a person with good immunity. The apple-jelly colour on diascopy reflects granulomatous infiltrate, and it is treated with antitubercular therapy.
Option by option
A. Lepromatous leprosy
Lepromatous leprosy shows symmetric nodules with loss of eyebrows and no apple-jelly sign.
B. Discoid lupus erythematosus
Discoid lupus has scarring, follicular plugging and atrophy rather than apple-jelly nodules.
C. Sarcoidosis
Sarcoidosis may show apple-jelly colour but is a noninfectious diagnosis of exclusion with sterile granulomas.
D. Lupus vulgaris (correct)
Correct. Apple-jelly nodules on diascopy are classic.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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