Rare Case of Multifocal Cutaneous Tuberculosis Verrucosa Cutis: Posing Clinical and Histopathological Diagnostic Dilemma

Abstract

Introduction: Tuberculosis is an ancient universal health problem, with cutaneous tuberculosis being a rare extra pulmonary form that accounts for only 0.15-2%. Here we report a case of elderly female diagnosed with multifocal, multicentric Tuberculosis verrucosa cutis. Presentation of Case: Sixty nine year old female presented to the skin out-patient department (OPD) at a tertiary care center, with chief complaints of multiple, multifocal asymptomatic raised verrucous lesions initially over the right upper limb and face, which insidiously progressed to involve lower limbs and nape of the neck, noticed from past 14 years. Based on histopathological features and clinical examinations, diagnosis of tuberculosis verrucosa cutis was made and patient was started on category 1 anti-tubercular treatment. Discussion and Conclusion: Tuberculosis verrucosa cutis occupies a pre-eminent position across the spectrum of cutaneous tuberculosis. Tuberculosis verrucosa cutis is positioned between lupus vulgaris and scrofuloderma. Tuberculosis verrucosa cutis is no longer the most frequent type of skin tuberculosis. Present rare case of multifocal tuberculosis verrucosa cutis, display histopathologic features in favor of tuberculosis verrucosa cutis. Partial remission in spite of long term anti-tubercular therapy and other modalities of treatment, as in this case report, tuberculosis verrucosa cutis remains a diagnostic dilemma difficult to be solved.