Lupus vulgaris over the earlobe with atypical milia formation

We report a case of a 69-year-old woman with recurrent reddish-brown plaques over the left auricle with milia formation. Diascopy showed an ‘apple jelly’ appearance. Histopathology revealed inflammatory epithelioid granulomas with mild central caseous necrosis. A QuantiFERON TB Gold test, staining for acid-fast bacillus and tissue culture, were negative, and the Mantoux test was weakly positive. The diagnosis of lupus vulgaris was based on a positive polymerase chain reaction for Mycobacterium tuberculosis DNA in both lesions. A triad antitubercular therapy was introduced and the patient’s lesions completely resolved within 6 months, with transient increased milia formation over the lesions.