Cutaneous Tuberculosis Revealed by Erythema Nodosum

Tuberculosis is a major public health problem in developing countries. Cutaneous tuberculosis is a rare form of extra pulmonary tuberculosis and represents a real diagnostic challenge because of its pauci-bacillary nature. Erythema nodosum is an exceptional skin manifestation of cutaneous tuberculosis.

We report the case of a 62-year-old female with a 10-year-old history of an atypical recurrent erythema nodosum. The Tuberculin intradermal reaction was strongly positive, with a biopsy of the subcutaneous lumps showing granulomatous tuberculoid lesions with caseous necrosis suggesting a cutaneous tuberculosis.

Treatment with anti-tuberculosis drugs provided recovery without recurrence of the skin lesions.

Erythema nodosum is an exceptional manifestation of cutaneous tuberculosis. Atypical recurrent lesions, resistant to treatment in an endemic country should be suggestive to cutaneous tuberculosis and the confirmation is established with biopsy. Medical treatment based on anti-tuberculosis chemotherapy allows healing.