Cutaneous Tuberculosis Presenting as a Chronic Non-healing Ulcer in a Child: Diagnostic Challenges in a Resource-Limited Setting – A Case Report and Literature Review

Abstract

Cutaneous tuberculosis (CTB) is a rare manifestation of extrapulmonary tuberculosis. It commonly
presents as a chronic, non-healing skin ulcer among individuals in tuberculosis-endemic, resource-limited
settings where access to confirmatory diagnostics such as histopathology or molecular testing is
frequently unavailable.

We present an 8-year-old girl from Northcentral Nigeria who presented with a 12- month history of a painless, non-healing ulcer on the anterior chest wall. The lesion began as a furuncle and evolved into ulcers with serous discharge, elevated erythematous margins, and a fibrinous base. Investigations done included chest X-ray, HIV test, Mantoux (4 mm induration), FBC, ESR, and wound culture, which were within normal limits. Facilities for Histopathology, AFB and PCR were unavailable.

After excluding differentials such as Buruli ulcer, deep fungal infection, and leishmaniasis, a presumptive
diagnosis of scrofuloderma was made. She was enrolled in the national DOTS program and commenced on antituberculosis therapy. Cessation of discharge, >50% reduction in ulcer size, and granulation tissue formation were evident at 1 and 3 months. Complete epithelialization with minimal scarring occurred by 6 months.

This case highlights the critical need for clinical vigilance and for considering CTB as a differential
diagnosis for chronic paediatric ulcers unresponsive to conventional antibiotic therapy in high-burden,
resource-constrained regions.