Delayed diagnosis of cutaneous tuberculosis in a child with chronic skin lesions: a case report

Enboklang Suting; Stacy A. Marbaniang; Marina Kharkongor; Pranjal Kalita

doi:10.18203/2349-3291.ijcp20262436

Authors

Enboklang Suting Department of Pediatrics, Shillong Medical College, Shillong, Meghalaya, India
Stacy A. Marbaniang Department of Dermatology, Shillong Medical College, Shillong, Meghalaya, India
Marina Kharkongor Department of Surgery, Shillong Medical College, Shillong, Meghalaya, India
Pranjal Kalita Department of Pathology, North Eastern Indira Gandhi Institute of Health Sciences, Shillong, Meghalaya, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20262436

Keywords:

Cutaneous tuberculosis, Lupus vulgaris, Skin biopsy, Complications

Abstract

Cutaneous tuberculosis (CTB) is an uncommon form of extrapulmonary tuberculosis in children and often pose a diagnostic challenge due to its varied clinical presentation. We report the case of a 7-year-old boy with chronic skin lesions for three years who received multiple empirical treatments without improvement. Examination of the skin lesion revealed erythematous to violaceous plaques with lichenification, scaling and excoriated areas. The margins are relatively well defined with smaller satellite papules. Skin biopsy showed epithelioid granulomas with Langhans giant cells and caseation consistent with CTB. He completed a 6-month course of anti-tubercular therapy (ATT) and the skin lesion healed with an unsightly scar. This case highlights the need to consider biopsy in chronic non-healing lesions to prevent long term cosmetic complications.

References

World Health Organization. Tuberculosis. Geneva: World Health Organization; 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/tuberculosis. Accessed on 02 June 2026.

Frankel A, Penrose C, Emer J. Cutaneous tuberculosis: a practical case report and review for the dermatologist. J Clin Aesthet Dermatol. 2009;2(10):19-27.

Barbagallo J, Tager P, Ingleton R, Hirsch RJ, Weinberg JM. Cutaneous tuberculosis: diagnosis and treatment. Am J Clin Dermatol. 2002;3(5):319-28.

Bravo FG, Gotuzzo E. Cutaneous tuberculosis. Clin Dermatol. 2007;25(2):173-80.

Gopinathan R, Pandit D, Joshi J, Jerajani H, Mathur M. Clinical and morphological variants of cutaneous tuberculosis and its relation to Mycobacterium species. Indian J Med Microbiol. 2001;19(4):193-6.

Ho CK, Ho MH, Chong LY. Cutaneous tuberculosis in Hong Kong: an update. Hong Kong Med J. 2006;12(4):272.

Sethuraman G, Reddy BSN. Cutaneous tuberculosis in children: a 20-year retrospective study. Pediatr Dermatol. 2013;30(6):676-80.

Tappeiner G, Wolff K. Tuberculosis and other mycobacterial infections. In: Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw-Hill. 2012;2273-92.

WHO. Guidelines for Treatment of Drug-Susceptible Tuberculosis and Patient Care, 2017. Available at: https://www.who.int/publications/i/item/9789241550000. Accessed on 02 June 2026.

National TB Elimination Programme (NTEP). Technical and Operational Guidelines for TB Control in India. 2024.

Chakrabarti A, Singh R. Cutaneous tuberculosis: a diagnostic challenge. Indian J Dermatol Venereol Leprol. 2010;76(6):599-602.

Kaul S, Jakhar D, Mehta S, Singal A. Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment. J Am Academy Dermatol. 2023;89(6):1107-19.

Van Zyl L, du Plessis J, Viljoen J. Cutaneous tuberculosis overview and treatment options. Am J Clin Dermatol. 2015;16(4):285-97.