Tubercular lesion of the foot presenting as epithelioma

Tuberculosis continues to be the biggest public health problem worldwide. Tuberculosis verrucosa cutis (TVC) is a verrucose form of cutaneous tuberculosis that occurs in previously sensitised individuals due to exogenous reinfection with Mycobacterium tuberculosis or Mycobacterium bovis, and it reflects good cell-mediated immunity. An elderly man presented with multiple fungating growths, which were painless but associated with mild itching and serous discharge, on the right foot for 40 years. The lesions were free from deeper structures and no inguinal lymphadenopathy was observed. A provisional diagnosis of epithelioma was made based on the features described. However, incisional biopsy indicated that the lesions were tuberculous. As part of the anti-tubercular therapy, the lesions were excised and the wounds covered with split-thickness skin graft. The patient's recovery was uneventful, with no graft loss or infection reported. This case illustrates the importance of recognising cutaneous forms of tuberculosis, especially TVC, as an important differential diagnosis of epithelioma.