Tuberculosis Verrucosa Cutis Presenting as a Chronic Verrucous Lesion in a Patient with Systemic Hypertension and Poliomyelitis: A Case Report

Abstract

Background: Tuberculosis verrucosa cutis (TBVC) is a rare form of cutaneous tuberculosis caused by direct inoculation of Mycobacterium tuberculosis into the skin of previously sensitised individuals. It usually presents as a slowly progressive verrucous lesion and may be misdiagnosed because of its resemblance to other dermatological conditions. Case Presentation: We report the case of a 55-year-old woman who presented with a dry cough of one and a half years' duration and an itchy skin lesion over the left buttock for six months. The lesion initially appeared as a small blackish patch measuring approximately 1 × 1 cm and gradually progressed to a verrucous plaque measuring about 10 × 10 cm. The patient had a medical history of poliomyelitis and systemic hypertension, for which she was receiving regular treatment. Dermatological examination revealed a solitary hyperpigmented verrucous plaque over the left posterolateral thigh. Histopathological examination of a skin biopsy showed hyperkeratosis, acanthosis, pseudoepitheliomatous hyperplasia, and well-formed granulomas with Langhans giant cells, confirming the diagnosis of tuberculosis verrucosa cutis. The patient was treated with standard anti-tubercular therapy while continuing antihypertensive medication. Conclusion: Tuberculosis verrucosa cutis is an uncommon form of cutaneous tuberculosis that may mimic other chronic skin conditions, leading to delayed diagnosis. Histopathological evaluation plays a key role in confirming the diagnosis. Early recognition and prompt initiation of anti-tubercular therapy are essential for effective management and favourable outcomes.